TLG在进展期胃癌患者中应用效果及对患者术后肠道屏障功能、血清疼痛介质的影响

Application effect of TLG in patients with advanced gastric cancer and its effect on postoperative intestinal barrier function and serum pain mediators

目的分析全腹腔镜胃癌根治术(TLG)在进展期胃癌(AGC)患者治疗中的应用价值。方法选取我院2017年普外腹腔镜外科5月至2019年5月收治的100例AGC患者,根据手术方法分为两组,微创组51例实施TLG,开腹组49例实施传统开腹术(TOS)。对比两组围手术期指标、术前及术后3 d、7 d胃肠屏障功能[二胺氧化酶(DAO)、D-乳酸、内毒素(ETX)]、疼痛介质[β内啡肽(β-Ep)、P物质(SP)、5-羟色胺(5-HT)]、生存期及并发症发生情况。结果微创组手术时间、术后下床时间、住院时间短于开腹组,术中出血量少于开腹组,淋巴结清扫个数、治疗费用多于开腹组(P<0.05);术后3 d、7 d微创组血清DAO、D-乳酸、EXT、β-Ep、SP、5-HT水平低于开腹组(P<0.05);微创组并发症发生率5.88%、术后1年生存率97.92%、术后3年生存率87.50%与开腹组(14.29%、95.56%、88.89%)比较,差异无统计学意义(P>0.05)。结论TLG治疗AGC安全性高,中短期疗效确切,能优化手术路径,减轻肠屏障功能损伤,促进术后恢复,缓解患者疼痛,但患者经济负担较重。

Objective To analyze the application value of total laparoscopic radical gastrectomy(TLG)in the treatment of advanced gastric cancer(AGC).Methods A total of 100 patients with AGC admitted to the Department of General External Laparoscopic Surgery of our hospital from May 2017 to May 2019 were selected and divided into two groups according to the surgical method.51 patients in the minimally invasive group were treated with TLG,and 49 patients in the open group were treated with traditional laparotomy(TOS).The perioperative indicators,gastrointestinal barrier function[diamine oxidase(DAO),D-lactic acid,endotoxin(ETX)],pain mediators[beta endorphin(β-Ep),substance P(SP),serotonin(5-HT)],survival time and complications.Results The operation time,postoperative bed time and hospital stay were shorter in the minimally invasive group than in the open group,the intraoperative bleeding was less than in the open group,and the number of lymph nodes cleared and the treatment cost were more than in the open group(P<0.05);the serum DAO,D-lactic acid,EXT,β-Ep,SP and 5-HT levels were lower in the minimally invasive group than in the open group at 3 and 7 d postoperatively(P<0.05);The complication rate in the minimally invasive group was 5.88%,the 1-year survival rate was 97.92%,and the 3-year survival rate was 87.50%.There was no significant difference between the minimally invasive group and the open group(14.29%,95.56%,88.89%)(P>0.05).Conclusion TLG in the treatment of AGC is safe and effective in the short and medium term.It can optimize the surgical path,reduce the damage of intestinal barrier function,promote postoperative recovery,and relieve the pain of patients,but the economic burden of patients is heavy.