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
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摘要
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.
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.
引文
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[16] 黄庆兴,马俊,曹爱红,等.三角吻合术在全腹腔镜远端胃癌根治术消化道重建中的应用[J].肿瘤研究与临床, 2017, 29(11):753-756.
[17] 臧潞,马君俊.全腹腔镜胃癌根治术消化道重建及相关并发症处理[J].中国实用外科杂志, 2017, 37(4):369-373.
[18] 张楠,苏向前,徐凯.直线吻合器与圆形吻合器在毕Ⅱ式吻合术中的应用比较[J].中华胃肠外科杂志, 2018, 21(2): 201-205.
[19] 马有伟,刘宏斌,韩晓鹏,等.毕Ⅱ式联合Braun吻合与单纯毕Ⅱ式吻合在全腹腔镜下远端胃癌根治术中的疗效比较[J].中国普外基础与临床杂志, 2016, 23(3) :311-314.
[20] 王玉宏,宋莹,王晓东,等.腹腔镜胃癌D2根治术治疗进展期胃癌的效果及对炎症因子和免疫功能的影响[J].现代肿瘤医学, 2018, 26(15): 2381-2384.
[2] 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.
[3] 胡建昆,赵林勇.腹腔镜胃癌根治术的难点与争议[J/CD].中华普外科手术学杂志(电子版),2018,12(2):91-94.
[4] 胡祥.胃癌腹主动脉周围淋巴结廓清的变迁及现状[J/CD].中华普外科手术学杂志(电子版),2017,11(6):451-456.
[5] 高波,董剑宏.三角吻合术在全腹腔镜远端胃癌根治术后消化道重建中的应用价值[J].中华消化外科杂志, 2016, 15(3):303-306.
[6] 王林俊,徐皓,徐泽宽.全腹腔镜胃癌根治术消化道重建方法选择与评价[J].中华胃肠外科杂志, 2017, 20(10):1113-1116 .
[7] 杨海涛,匡荣康.全腹腔镜下三角吻合术进行胃癌远端胃切除术消化道重建的安全性和可行性[J].实用癌症杂志, 2017, 32(10):1738-1740.
[8] 李士涛,季刚,冯江,等.不同消化道重建方式在腹腔镜远端胃癌手术中的效果比较[J].西南国防医药, 2017, 27(7):717-719.
[9] 余佩武,罗华星.腹腔镜胃癌手术规范化实施的策略与技术[J].中华消化外科杂志, 2015, 14(3):179-182.
[10] 应敏刚,杨春康.腹腔镜胃癌根治术并发症的防治策略[J].临床外科杂志, 2016, 24(11):819-821.
[11] 李子禹,陕飞,季加孚.中国全腹腔镜胃癌根治术现状调查与展望[J].中国实用外科杂志, 2017, 37(10) :1069-1072.
[12] 刘芳腾,朱培谦,欧阳喜,等.全腹腔镜下三角吻合治疗胃癌近期疗效的Meta分析[J].中华普通外科杂志, 2017, 32(1):67-72.
[13] 贾小安.腹腔镜下毕Ⅱ胃癌根治术后并发空肠梗阻等并发症的危险因素分析与处理[J].中国内镜杂志, 2017, 23(2):34-36.
[14] Kanaya S,Gomi T,Momoi H,et a1.Delta-shaped anastomosis in totally laparoscopic Billroth I gastrectomy: new technique of intraabdominal gastroduodenostomy[J]. J Am Coil Surg, 2002, 195(2):284-287.
[15] 王建锋,孙培春,吴刚,等.全腹腔镜远端胃切除术后三角吻合术在消化道重建中的应用效果[J].重庆医学, 2018, 47(16): 2229-2231.
[16] 黄庆兴,马俊,曹爱红,等.三角吻合术在全腹腔镜远端胃癌根治术消化道重建中的应用[J].肿瘤研究与临床, 2017, 29(11):753-756.
[17] 臧潞,马君俊.全腹腔镜胃癌根治术消化道重建及相关并发症处理[J].中国实用外科杂志, 2017, 37(4):369-373.
[18] 张楠,苏向前,徐凯.直线吻合器与圆形吻合器在毕Ⅱ式吻合术中的应用比较[J].中华胃肠外科杂志, 2018, 21(2): 201-205.
[19] 马有伟,刘宏斌,韩晓鹏,等.毕Ⅱ式联合Braun吻合与单纯毕Ⅱ式吻合在全腹腔镜下远端胃癌根治术中的疗效比较[J].中国普外基础与临床杂志, 2016, 23(3) :311-314.
[20] 王玉宏,宋莹,王晓东,等.腹腔镜胃癌D2根治术治疗进展期胃癌的效果及对炎症因子和免疫功能的影响[J].现代肿瘤医学, 2018, 26(15): 2381-2384.