标题：腹腔镜辅助与开腹远端胃癌根治术对机体血清炎性因子水平及近期疗效的影响

      作者：尹红 1，罗保平 1，李春亭 1，巴元明 2    (湖北中医药大学附属医院湖北省中医院普外科 1、肾内科 2，湖北 武汉 430060)

      卷次： 2017年28卷10期

      【摘要】 目的 比较腹腔镜辅助手术与开腹远端胃癌根手术效果及对血清炎性因子水平的影响。方法 选取2016年3~8月在湖北省中医院住院治疗的胃镜检查及病理检查明确诊断为胃癌的患者80例作为研究对象，根据数表法随机将其分为对照组和观察组，每组 40例。对照组实施开腹胃癌根治手术，观察组实施腹腔镜辅助胃根治术。比较两组患者手术过程、恢复指标情况及炎性因子变化。结果 观察组和对照组患者的手术时间[(113.7±22.2) min vs (138.6±22.7) min]，手术中出血量[(249.2±38.2) mL vs (545.3±64.3) mL]、肠道功能恢复[(51.2±13.1) h vs(81.3±21.6) h]、住院时间[(7.2±2.5) d vs (10.3±3.2) d]比较，观察组均低于对照组，差异均有统计学意义(P<0.05)；观察组患者术后1 d、3 d血浆白蛋白及总蛋白水平均高于对照组(P<0.05)，但术后7 d血浆白蛋白及总蛋白水平比较差异均无统计学意义(P>0.05)；两组患者术前白细胞(WBC)、C反应蛋白(CRP)、肿瘤坏死因子-α (TNF-α)、白细胞介素 6 (IL-6)水平比较差异均无统计意义(P>0.05)；观察组患者术后 24 h及术后 72 h血液及引流液中WBC、CRP、TNF-α、IL-6水平均低于对照组，差异均有统计学意义(P<0.05)。结论 腹腔镜胃癌根治手术近期疗效较佳，且炎症反应程度轻，临床应用安全。
      【关键词】 腹腔镜；胃癌；炎性因子；远端胃癌根手术
      【中图分类号】 R735.2 【文献标识码】 A 【文章编号】 1003—6350(2017）10—1575—03

Effects of laparoscopic assisted and open distal gastrectomy for gastric cancer on serum inflammatory factorlevels and short-term outcomes.
YIN Hong 1, LUO Bao-ping 1, LI Chun-ting 1, BA Yuan-ming 2. Department of GeneralSurgery 1, Department of Nephrology 2, Hubei Provincial Hospital of Traditional Chinese Medicine, Affiliated Hospital ofHubei University of Traditional Chinese Medicine, Wuhan 430060, Hubei, CHINA
【Abstract】 Objective To compare the effect of laparoscopic surgery and open surgery for distal gastric cancerradical operation and influence on serum levels of inflammatory cytokines. Methods A total of 80 cases of gastric can-cer patients, who admitted to Hubei Provincial Hospital of Traditional Chinese Medicine and diagnosed by endoscopyand pathological examination from March 2016 to August 2016, were selected as the research objects and divided intothe observation group and the control group according to digital random method, with 40 cases in each group. The con-trol group received open surgery for gastric cancer. The observation group received laparoscopic assisted radical resec-tion of the stomach. Surgical procedures, recovery indicators and changes in inflammatory factors between the twogroups were compared. Results The operation time, intraoperative blood loss, recovery of intestinal function andlength of hospital stay in the observation group were (113.7±22.2) min, (249.2±38.2) mL, (51.2±13.1) h, (7.2±2.5) d, re-spectively, which were significantly lower than (138.6±22.7) min, (545.3±64.3) mL, (81.3±21.6) h, (10.3±3.2) d of thecontrol group (P<0.05). One day and three days after the operation, the plasma albumin and total protein levels in the ob-servation group were higher than those in the control group (P<0.05). Seven days after the operation, there was no signif-icant difference between the two groups in plasma albumin and total protein levels (P>0.05). There was no significantdifference between the two groups in white blood cell (WBC), C-reactive protein (CRP), tumor necrosis factor-α(TNF-α) and interleukin-6 (IL-6) before surgery (P>0.05). Twenty-four hours and seventy-two hours after the opera-tion, the levels of WBC of drainage fluid, CRP, TNF-α and IL-6 in the observation group were lower than those in thecontrol group (P<0.05). Conclusions Laparoscopic radical operation for gastric cancer has a better short-term curativeeffect, and the degree of inflammatory reaction is mild with good clinical safety.
      【Key words】 Laparoscopy; Gastric cancer; Inflammatory factor; Distal gastrectomy for gastric cancer·论 著·doi:10.3969/j.issn.1003-6350.2017.10.009基金项目：湖北省重大科技创新计划项目(编号：2014BKB082)