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目的比较常规开腹手术与腹腔镜辅助下治疗胃癌的近期效果。方法选取2013年10月至2015年9月收治的胃癌患者86例,随机分为腹腔镜辅助组38例,常规开腹组48例。腹腔镜辅助组采用腹腔镜系统辅助完成胃癌切除以及消化道重建,常规开腹组采用常规开腹手术进行胃癌根治术。观察比较两组手术相关指标及对免疫功能、炎症因子和凝血功能的影响,以及近期并发症发生情况。结果腹腔镜组平均术中出血量、术后胃肠功能恢复时间、术后住院时间优于常规开腹组(P均<0.01);但手术时间长于常规开腹组(P<0.05)。两组淋巴结清扫数量分别为(21.89±5.67)、(23.19±4.33)枚,差异无统计学意义(P>0.05)。两组术后CD3、CD4、CD8和CD4/CD8较术前均明显降低(P均<0.05),但腹腔镜组术后4项指标均高于常规开腹组术后(P均<0.05)。两组术后CRP和IL-6水平均明显增加,与术前比较差异均有统计学意义(P均<0.05),但腹腔镜组术后2项指标均低于常规开腹组(P均<0.05)。与术前相比,两组患者术后凝血酶时间(TT)均明显降低,纤维蛋白原(FIB)、D-二聚体(D-D)水平明显升高(P均<0.05),但腹腔镜组患者术后TT低于常规开腹组术后,FIB、D-D水平高于常规开腹组术后(P均<0.05)。腹腔镜组、开腹组患者术后总并发症发生率分别为18.42%、20.83%,差异无统计学意义(P>0.05),但腹腔镜组下肢静脉血栓发生率高于开腹组,差异有统计学意义(P<0.05)。结论腹腔镜辅助胃癌治疗,可明显减少手术创伤,对免疫功能影响较小,加速患者术后康复,但应注意提高手术操作技巧,加强对下肢静脉脉血栓的预防。
Objective To compare the short-term effects of conventional laparoscopic surgery and laparoscopic-assisted treatment of gastric cancer. Methods Totally 86 gastric cancer patients who were treated from October 2013 to September 2015 were randomly divided into laparoscopic assisted group (38 cases) and conventional laparotomy group (48 cases). Laparoscopic assisted group using laparoscopic system to complete the resection of gastric cancer and digestive tract reconstruction, conventional open group using conventional laparotomy for radical resection of gastric cancer. Observed and compared two groups of surgery-related indicators and immune function, inflammatory factors and coagulation function, as well as the occurrence of recent complications. Results The mean intraoperative blood loss, postoperative gastrointestinal function recovery time and postoperative hospital stay were better than those in the conventional open group (P <0.01). However, the operation time was longer than that in the conventional laparotomy group (P <0.05). The number of lymph node dissection in the two groups was (21.89 ± 5.67) and (23.19 ± 4.33), respectively, with no significant difference (P> 0.05). The postoperative CD3, CD4, CD8 and CD4 / CD8 of the two groups were significantly lower than those before operation (all P <0.05), but the postoperative indexes of laparoscopic group were all higher than those of the conventional open group (all P <0.05) . The levels of CRP and IL-6 in both groups were significantly increased after operation compared with those before operation (all P <0.05), but both indexes in laparoscopic group were lower than those in conventional laparotomy group <0.05). The postoperative thrombin time (TT), fibrinogen (FIB) and D-dimer (DD) levels in both groups were significantly higher than those before operation (all P <0.05), but laparoscopy The postoperative TT was lower in the group than that in the conventional group, and the levels of FIB and DD were higher than those in the conventional group (P <0.05). The incidence of postoperative complications in laparoscopic group and open group were 18.42% and 20.83% respectively, with no significant difference (P> 0.05), but the incidence of venous thrombosis in lower laparoscopic group was higher than that in open group There was statistical significance (P <0.05). Conclusion Laparoscopic assisted gastric cancer treatment can significantly reduce the surgical trauma, less impact on immune function and accelerate the recovery of patients, but should pay attention to improve surgical skills and strengthen the prevention of lower extremity venous thrombosis.