根治性远端胃切除术治疗急诊胃窦癌并穿孔患者临床疗效及对凝血功能的影响

Clinical outcomes and impact on coagulation in patients with emergency antral carcinoma and perforation treated with radical distal gastrectomy

目的 探讨根治性远端胃切除术治疗急诊胃窦癌并穿孔患者的临床疗效及患者凝血功能的影响。方法 选取2019年8月—2021年2月江门市新会区人民医院急诊收治的72例胃窦癌并穿孔患者作为研究对象,根据治疗方法分为开腹组和腹腔镜组,开腹组(n=38)接受开腹根治性远端胃切除术,腹腔镜组(n=34)接受腹腔镜根治性远端胃切除术,比较2组患者的临床疗效及凝血功能水平。结果 腹腔镜组患者手术出血量比开腹组少,术后排气时间、术后离床活动时间、住院时间均比开腹组短,手术时间比开腹组长,差异均有统计学意义(P<0.05)。腹腔镜组患者术后并发症发生率比开腹组低,差异有统计学意义(P<0.05)。术后12 h、术后24 h 2组活化部分凝血酶原时间均明显降低,但腹腔镜组变化幅度更大,差异均有统计学意义(P<0.05);术后12 h、术后24 h 2组纤维蛋白原、D-二聚体水平均明显升高,但腹腔镜组变化幅度更大,差异均有统计学意义(P<0.05)。结论 在根治性远端胃切除术对急诊胃窦癌并穿孔患者的治疗中,与开腹手术相比,腹腔镜手术能有效减少对患者造成的创伤,患者术后并发症少,康复更快,但对患者凝血功能有一定影响,需引起重视。

Objective To investigate the clinical efficacy of radical distal gastrectomy in patients with emergency antral carcinoma and perforation and the effect of patients'coagulation function.Methods Seventy two patients with antral carcinoma and perforation,who were admitted to the emergency department of Xinhui District People's Hospital,Jiangmen,Guangdong,China,from August 2019 to February 2021,were selected as study subjects,they were divided into open and laparoscopic groups according to treatment,with open group(n=38)receiving open radical distal gastrectomy and laparoscopic group(n=34)receiving laparoscopic radical distal gastrectomy,and the clinical outcomes and coagulation levels were compared between the two groups.Results The laparoscopic group showed lower operative blood loss,postoperative flatus time,postoperative ambulation time,and hospital stay than the open group,and the operative time was longer than the open group,all with significant differences(P<0.05).The laparoscopic group had a lower incidence of postoperative complications than the open group,and the difference was statistically significant(P<0.05).The activated partial prothrombin time was significantly lower in both groups 12 h and 24 h after surgery,but the laparoscopic group had more variable values,all differences being statistically significant(P<0.05).Fibrinogen and D-dimer levels were significantly increased in both groups 12 h and 24 h after surgery,but the laparoscopic group had more variable changes,all of which were statistically significant(P<0.05).Conclusion In the treatment of patients with emergency antral carcinoma and perforation by radical distal gastrectomy,compared with open surgery,laparoscopic surgery can effectively reduce the trauma caused to patients,and the patients have fewer postoperative complications and faster recovery,but it has some effect on coagulation function and needs to cause significant problems.