[1]王政强,王　春.腹腔镜胃癌根治术与开腹胃癌根治术治疗胃癌疗效比较[J].新乡医学院学报,2020,37(4):386-390.[doi:10.7683/xxyxyxb.2020.04.020]
　WANG Zhengqiang,WANG Chun.Comparison of the curative effect between laparoscopic radical gastrectomy and open radical gastrectomy in the treatment of gastric cancer[J].Journal of Xinxiang Medical University,2020,37(4):386-390.[doi:10.7683/xxyxyxb.2020.04.020]
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腹腔镜胃癌根治术与开腹胃癌根治术治疗胃癌疗效比较
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
37
期数:
2020年4
页码:
386-390
栏目:
临床研究
出版日期:
2020-04-05

文章信息/Info

Title:
Comparison of the curative effect between laparoscopic radical gastrectomy and open radical gastrectomy in the treatment of gastric cancer
作者:
王政强; 王　春
（长安医院普外科，陕西　西安　710016）
Author(s):
WANG Zhengqiang; WANG Chun
(Department of General Surgery,Chang′an Hospital,Xi′an 710016,Shaanxi Province,China)
关键词:
胃癌; 腹腔镜手术; 开腹手术; 胃癌根治术
Keywords:
gastric cancer; laparoscopic operation; laparotomy; radical gastrectomy for gastric cancer
分类号:
R735.2
DOI:
10.7683/xxyxyxb.2020.04.020
文献标志码:
A
摘要:
目的　比较腹腔镜胃癌根治术与开腹胃癌根治术治疗胃癌的临床效果。方法　选择2014年6月至2018年8月长安医院收治的127例胃癌患者为研究对象，根据手术方法将患者分为腹腔镜手术组（n=64）和开腹手术组（n=63）；开腹手术组患者采用开腹胃癌根治术治疗，腹腔镜手术组患者采用腹腔镜胃癌根治术治疗。观察2组患者手术时间、术中出血量、手术切口长度、术后住院时间及术后肛门排气时间，分别于术前及术后第3天检测血清一氧化氮（NO）、内皮素-1（ET-1）、血红素加氧酶-1（HO-1）、β-内啡肽（β-EP）水平及凝血酶原时间（PT）、纤维蛋白原（FIB）、活化部分凝血活酶时间（ATPP），计算国际标准化比值（INR）。观察2组患者术后并发症发生情况。结果　与开腹手术组比较，腹腔镜手术组患者手术时间短，术中出血量少，手术切口短，术后肛门排气早，术后住院时间短（P<0.05)。2组患者术前血清NO、ET-1、HO-1及β-EP水平比较差异均无统计学意义（P>0.05）；开腹手术组患者术后第3天血清NO、ET-1、HO-1及β-EP水平显著高于术前（P<0.05）；腹腔镜手术组患者术后第3天血清HO-1、β-EP水平显著高于术前（P<0.05），腹腔镜手术组患者术后第3天血清NO、ET-1水平与术前比较差异无统计学意义（P>0.05）；术后第3天，腹腔镜手术组患者血清NO、ET-1、HO-1及β-EP水平显著低于开腹手术组（P<0.05）。2组患者术前PT、FIB、APTT、INR比较差异无统计学意义（P>0.05）。开腹手术组患者术后第3天PT显著短于术前，血浆FIB水平显著高于术前（P<0.05）；开腹手术组患者术后第3天APTT、INR与术前比较差异无统计学意义（P>0.05）。腹腔镜手术组患者术后第3天PT、APTT短于术前，INR显著小于术前，血浆FIB水平显著高于术前（P<0.05）。术后第3天，腹腔镜手术组患者血浆FIB水平高于开腹手术组，PT、APTT短于开腹手术组，INR小于开腹手术组（P<0.05）。腹腔镜手术组和开腹手术组患者并发症发生率分别为6.25%（4/64）、19.05%（12/63），腹腔镜手术组患者并发症发生率低于开腹手术组（χ2=4.434，P<0.05)。结论　与开腹胃癌根治术比较，腹腔镜胃癌根治术具有术中出血量少、手术应激反应小、并发症少等优势，但腹腔镜胃癌根治术对患者的凝血功能影响较大，应注意预防凝血功能异常所致术后血栓形成。
Abstract:
Objective　To compare the clinical effect of laparoscopic radical gastrectomy and open radical gastrectomy in the treatment of gastric cancer.Methods　A total of 127 patients with gastric cancer admitted to Chang′an Hospital from June 2014 to August 2018 were selected as the study objects,and the patients were divided into laparoscopic operation group (n=64) and open operation group (n=63) according to the operation methods.The patients in the open operation group were treated with open radical gastrectomy,and the patients in the laparoscopic operation group were treated with laparoscopic radical gastrectomy.The operation time,intraoperative bleeding volume,incision length,postoperative hospitalization time and postoperative anal exhaust time were observed.The levels of serum nitric oxide (NO),endothelin-1 (ET-1),heme oxygenase-1 (HO-1),β-endorphin (β-EP) and prothrombin time (PT),fibrinogen (FIB),activated partial thromboplastin time (ATPP) were measured before and three days after operation.The international normalized ratio (INR) was calculated.The postoperative complications of the patients in the two groups were observed.Results　Compared with the open operation group,the patients in the laparoscopic operation group had shorter operation time,less intraoperative bleeding volume,shorter incision length,earlier anal exhaust and shorter hospitalization time (P<0.05).There was no significant difference in the serum NO,ET-1,HO-1 and β-EP levels between the two groups before operation (P>0.05).The levels of serum NO,ET-1,HO-1 and β-EP at three days after operation were significantly higher than those before operation in the open operation group (P<0.05).The levels of serum HO-1 and β-EP at three days after operation were significantly higher than those before operation in the laparoscopic operation group (P<0.05).There was no significant difference in the level of serum NO and ET-1 between the three days after operation and before operation in the laparoscopic operation group (P>0.05).The levels of serum NO,ET-1,HO-1 and β-EP in the laparoscopic operation group were significantly lower than those in the open operation group on the third day after operation (P<0.05).There was no significant difference in PT,FIB,APTT and INR between the two groups (P>0.05).The PT was significantly shorter,and the plasma FIB level was significantly higher on the third day after operation than those before operation in the open surgery group (P<0.05).There was no significant difference in APTT and INR between the third day after operation and before operation in the open surgery group (P>0.05).Compared with those before operation,the PT and APTT were shorter,the INR was lower and the FIB level was higher on the third day after operation in the laparoscopic operation group (P<0.05).On the third day after operation,the plasma FIB level in the laparoscopic operation group was higher than that in the open operation group,the PT and APTT in the laparoscopic operation group were shorter than those in the open operation group,and the INR in the laparoscopic operation group was lower than that in the open operation group (P<0.05).The incidence of complications in the laparoscopic operation group and the open operation group was 6.25% (4/64) and 19.05% (12/63),respectively.The incidence of complications in the laparoscopic operation group was lower than that in the open operation group (χ2　=4.434,P<0.05).Conclusion　Compared with open radical gastrectomy,the laparoscopic radical gastrectomy has the advantages of less bleeding,less operative stress response and fewer complications.However,the laparoscopic radical gastrectomy has a greater impact on the coagulation function of patients,so we should pay attention to the prevention of postoperative thrombosis caused by coagulation disorder.

参考文献/References:

［1］　符涛，季加孚.胃癌诊疗的热点和问题［J］.中国肿瘤临床，2016，43（1）：2-5.
［2］　李晓峰，杨生虎，韩云，等.腹腔镜下 D2根治术治疗局部进展期远端胃癌30例效果观察［J］.山东医药，2016，56（13）：54-56.
［3］　齐勇，吴文涌，孟翔凌，等.手助腹腔镜胃癌D2手术的临床疗效分析［J］.中国微创外科杂志，2016，16（2）：122-126.
［4］　陆俊，黄昌明，郑朝辉，等.腹腔镜根治性全胃切除术治疗老年原发性胃癌患者的倾向评分配比预后分析［J］.中华消化外科杂志，2016，15（3）：221-227.
［5］　陈孝平，汪建平.外科学［M］.8版.北京：人民卫生出版社，2013：213.
［6］　左婷婷，郑荣寿，曾红梅，等.中国胃癌流行病学现状［J］.中国肿瘤临床，2017，44（1）：52-58.
［7］　王宝华，王宁，冯雅靖，等.1990年与2013年中国人群胃癌疾病负担分析［J］.中华流行病学杂志，2016，37（6）：763-767.
［8］　GALLAGHER K A,OBI A T,ELFLINE M A,et al.Alterations in macrophage phenotypes in experimental venous thrombosis［J］.J Vasc Surg Venous Lymphat Disord,2016,4(4):463-471.
［9］　周宏，夏加增，陈义钢.胃癌腹腔镜辅助手术与开腹手术的单中心回顾性对照研究［J］.实用医学杂志，2018，34（19）：3255-3259.
［10］　冯志刚，杨雨民.胃癌患者微创全胃切除的手术效果研究［J］.中国内镜杂志，2018，24（7）：51-55.
［11］　BOURGOUIN S,MANCINI J,MONCHAL T,et al.How to predict difficult laparoscopic holecystectomy proposal for a simple preoperative scoring system［J］.Am J Surg,2016,212(5):873-881.
［12］　许国梁.腹腔镜辅助远端胃大部切除术与传统开腹胃癌切除术对老年胃癌患者血清TNF-α、IL-6、CRP的影响及短期疗效比较［J］.中国老年学杂志，2017，37（18）：4581-4582.
［13］　彭汉武.快通道外科技术联合腹腔镜在老年患者胃癌根治术中的应用研究［J］.中国现代医学杂志，2017，27（24）：85-90.
［14］　张亦磊，张佳，李涛，等.腹腔镜与开腹手术对于进展期远端胃癌患者术后应激反应及临床疗效研究［J］.中华普外科手术学杂志：电子版，2018，12（3）：215-218.DOI:10.3877/cma.j.issn.1674-3946.2018.03.012．
［15］　赵刚，武青生，穆元忠，等.腹腔镜辅助下D2根治术对进展期远端胃癌患者临床疗效、术后并发症及住院时间的影响［J］.癌症进展，2017，15（11）：1335-1337，1341.
［16］　杜媛，徐建，王卫东.全凭静脉麻醉与静脉-吸入复合麻醉对老年患者腹腔镜辅助胃癌根治术后苏醒质量的影响［J］.新乡医学院学报，2018，35（7）：616-619.
［17］　BARTON C A.Treatment of coagulopathy related to hepatic insufficiency［J］.Crit Care Med,2016,44(10):1927-1933.
［18］　梁節.腹腔镜下胃癌手术后血液高凝状态发生的监测及护理［J］.血栓与止血学，2017，23（2）：333-335.

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更新日期/Last Update: 2020-04-05