腹腔镜胃癌根治术对肠道屏障功能损伤的研究分析

目的:对比腹腔镜与传统开腹胃癌根治术对胃癌患者肠道屏障功能的损伤及手术效果,为临床术式选择提供依据。方法:选择2008年10月至2012年10月113例胃癌患者,其中57例为观察组,行腹腔镜胃癌D2根治术;56例为对照组,行开腹胃癌D2根治术。观察两组患者手术时间、失血量、切口长度、肠道功能恢复时间、清除淋巴结数量、住院时间及术后第1天、第3天、第5天、第7天血浆D-乳酸浓度、血浆二胺氧化酶浓度、C-反应蛋白值等。结果:两组淋巴结清除数量差异无统计学意义(P>0.05);手术时间观察组长于对照组,但在出血量、切口长度、肠道功能恢复时间及住院时间方面观察组明显优于对照组,差异有统计学意义(P<0.01)。两组患者术后第1天、第3天血浆D-乳酸浓度、二胺氧化酶浓度及C-反应蛋白值差异有统计学意义(P<0.05);术后第5天、第7天血浆D-乳酸浓度、二胺氧化酶浓度及C-反应蛋白值差异有统计学意义(P<0.01)。结论:腹腔镜胃癌根治术是安全、有效的微创手术,与传统开腹胃癌根治术相比,对肠道屏障功能的损伤更小,更利于患者术后快速恢复,值得临床推广。

The research and analysis of intestinal barrier function injury caused by laparoscopic radical surgery for gastric cancer

Objective：To compare the damage of intestinal barrier function and operative effect of laparoscopic and traditional open radical surgery for gastric cancer, and provide the basis for choice of clinical operations. Methods ： From Oct. 2008 to Oct. 2012, 113 patients with gastric cancer were selected ,57 patients in the observation group underwent laparoscopie D2 radical operation for gas- tile cancer,56 cases in control group underwent open D2 radical surgery. The operation time, blood loss, length of incision, the intestinal function recovery time, harvested lymph node, hospital stay, plasma D-lactic acid concentration, the concentration of plasma diamine oxi- dase, C-reactive protein values on the I st,3rd,5th, and 7th day after operation of the two groups were observed. Results：The number of lymph node harvested of the two groups were not statistically different （P 〉 0.05 ）. The operation time of observation group was longer than that of the control group, but blood loss, length of incision, the intestinal function recovery time and hospital stay of observation group were superior to those of control group （P 〈0.01 ）. Plasma D-lactic acid concentration ,concentration of diamine oxidase and C- reactive protein values of two groups on postoperative 1st ,3rd day were significantly different （P 〈 0.05 ） ,on postoperative 5th ,7th day the differences were statistically significant （P 〈 0. 01 ）. Conclusions：Laparoseopie radical surgery for gastric cancer is a safe effective and minimally invasive surgery, compared with the traditional open radical operation, the damage of the intestinal barrier function is small, is good for postoperative fast recovery, worth clinical promotion.