全腔镜远端胃癌根治术对比腹腔镜辅助手术治疗胃癌的疗效及对炎症因子和免疫功能的影响

Curative effect of totally laparoscopic distal gastrectomy for distal gastric cancer compared with laparoscopic assisted distal gastrectomy for gastric cancer and its influence on inflammatory factors and immune function

目的:比较全腔镜远端胃癌根治术(TLDG)与腹腔镜辅助胃癌根治术(LADG)治疗胃癌的疗效及对炎症因子和免疫功能的影响。方法:选取施行微创手术治疗的胃癌患者199例,根据手术方式的不同分为TLDG组(n=88)和LADG组(n=111)。记录两组手术一般情况、术后恢复情况;比较两组术前和术后3 d血清炎症因子[白细胞(WBC)、C-反应蛋白(CRP)及白细胞介素-6(IL-6)]和T淋巴细胞亚群水平差异及两组术后并发症情况。结果:TLDG组术中出血量少于LADG组,切口长度短于LADG组(P<0.05);TLDG组首次肛门排气时间及住院时间短于LADG组(P<0.05);术后非甾体镇痛药使用量少于LADG组(P<0.05)。术后3 d,两组WBC、CRP、IL-6水平均增高(P<0.05);且TLDG组低于LADG组(P<0.05)。术后3 d,两组CD3^(+)、CD4^(+)及CD8^(+)水平均下降(P<0.05);且TLDG组高于对照组(P<0.05)。结论:相对LADG,TLDG手术切口小,术后炎症反应轻微,对免疫功能的影响较小,更利于胃癌患者术后恢复。

Objective:To compare the efficacy of total endoscopic distal gastrectomy(TLDG)and laparoscopic assisted distal gastrectomy(LADG)in the treatment of gastric cancer and their effects on inflammatory factors and immune function.Methods:A total of 199 patients with gastric cancer were treated with minimally invasive surgery,according to the different surgical methods,they were divided into TLDG group(n=88)and LADG group(n=111).The general situation and postoperative recovery of the two groups were recorded.The levels of serum inflammatory factors[white blood cell(WBC),C-reactive protein(CRP)and interleukin-6(IL-6)]and T lymphocyte subsets 1 day before operation and 3 days after operation,and the postoperative complications were compared between the two groups.Results:The intraoperative blood loss in TLDG group was less than that in LADG group,and the incision length was shorter than that in LADG group(P<0.05).The first anal exhaust time and hospitalization time in the TLDG group were shorter than those in the LADG group(P<0.05),and the postoperative use of non-steroidal analgesics was less than that in the LADG group(P<0.05).3 days after operation,the levels of WBC,CRP and IL-6 in the two groups were higher than those before operation(P<0.05),and the TLDG group was lower than the LADG group(P<0.05).3 days after operation,the levels of CD3^(+),CD4^(+)and CD8^(+)in the two groups decreased compared with those before operation(P<0.05),and the TLDG group was higher than the control group(P<0.05).Conclusion:Compared with LADG,TLDG has smaller incision,mild postoperative inflammatory response and less impact on immune function,which is more conducive to postoperative recovery of gastric cancer patients.