腹腔镜技术用于胃癌远端根治术的消化道重建方式探讨及术后炎性反应分析

Clinical analysis of digestive tract reconstruction and postoperative inflammatory response after laparoscopic distal gastrectomy for gastric cancer

目的本研究旨在探讨腹腔镜技术用于胃癌远端根治术的消化道重建方式及术后炎性反应。方法回顾性分析2014年4月至2017年5月收治的72例行胃癌远端根治术患者,根据所采用的消化道重建方式的不同分为两组,其中研究组患者35例采用全腹腔镜下三角吻合术,而对照组患者37例则采用全腹腔镜下毕Ⅱ式联合Braun吻合术。两组数据的统计学分析采用SPSS21.0软件进行,手术相关指标,术后胃肠功能、血清炎性因子水平等均以■描述,采用独立t检验;术后并发症等采用χ~2检验比较分析;P<0.05差异存在统计学意义。结果研究组患者的术中出血量、切口长度、住院时间等指标均低于对照组患者(P<0.05);研究组患者的排气时间、排便时间、肠鸣音恢复时间等指标明显低于对照组患者(P<0.05);术后,研究组患者的IL-8、 IL-6、 TNF-α和hs-CRP等因子水平均明显低于对照组患者(P<0.05);两组患者的术后并发症差异无统计学意义(P>0.05)。结论采用三角吻合术作为腹腔镜胃癌远端根治术的消化道重建方式,可显著改善患者的手术相关指标,促进胃肠功能的恢复,降低术后炎性反应,值得临床进一步推广应用。

Objective To analyze the gastrointestinal reconstruction and postoperative inflammatory response after laparoscopic distal gastrectomy for gastric cancer. Methods From April 2014 to May 2017, retrospective analysis were performed in 72 patients who received laparoscopic distal gastrectomy for gastric cancer, according to the method of gastrointestinal reconstruction, 35 patients underwent triangular anastomosis were divided into study group and 37 patients underwent Braun anastomosis were divided into control group. The data were analyzed by using SPSS21.0 software. Measurement data such as surgery-related indicators, postoperative gastrointestinal function, and inflammatory response level were presented as mean+standard deviation and were examined by using t test. Postoperative complicationrate were expressed as %, and were compared with 2 test. P <0.05 was considered as significant difference.Results The intraoperative blood loss, length of incision, hospitalization time in the study group were significantly lower than those in the control group respectively(P<0.05). The exhaust time, defecation time, and bowel sound recovery time of the study group were significantly lower than those of the control group respectively(P<0.05). After operation, the levels of IL-8, IL-6, TNF-α and hs-CRP in the study group were significantly lower than those in the control group respectively(P<0.05). There was no significant difference of postoperative complications between 2 groups(P>0.05). Conclusion Triangular anastomosis for laparoscopic distal gastrectomy could significantly improve the surgical related indicators, promote the recovery of gastrointestinal function, and reduce postoperative inflammatory responses, which is worth further clinical application.