达芬奇机器人胃癌根治术对患者胃肠动力及胃肠激素的影响

目的 研究达芬奇机器人胃癌根治术对患者胃肠动力和激素的影响。 方法 选择行胃癌根治术的患者217例，按照不同手术方式分为达芬奇组和开腹手术组。记录两组术后肠鸣音恢复时间、首次肛门排气时间并测定术前及术后胃肠激素、手术相关因素及炎性因子水平后行统计分析。 结果 达芬奇组术后肠鸣音恢复时间和首次肛门排气时间均短于开腹组（均P<0.05）。两组术后24 h血液胃动素、胃泌素和生长抑素的测量值均明显较术前12 h下降（均P<0.05），而血管活性肠肽的测量值均显著升高（P<0.05）；术后24 h达芬器组胃动素和胃泌素的测量值均高于开腹组（均P<0.05），而血管活性肠肽的测量值低于开腹组（P<0.05）；所有患者术后肠鸣音恢复时间和首次肛门排气时间与术后24 h血液胃动素、胃泌素值负相关（均P<0.05），与血管活性肠肽值正相关（P<0.05）。两组手术时长、术中出血量、术后拔除引流管时间、术后疼痛VAS评分以及炎性相关因子间差异有统计学意义（均P<0.05）。 结论 达芬奇机器人胃癌根治术患者胃肠动力恢复明显快于传统开腹术；而创伤引起的炎性反应、应激反应可能是影响患者胃肠激素分泌的重要因素。

Effect of Da Vinci Robot Radical Gastrectomy on Gastrointestinal Motility and Gastrointestinal Hormones of Gastric Cancer Patients

Objective To investigate the effect of Da Vinci robot radical gastrectomy on gastrointestinal motility and hormones of gastric cancer patients. Methods We selected 217 patients who underwent radical gastrectomy. According to different surgical methods, the patients were divided into Da Vinci operation group and open operation group.The recovery time of bowel sounds and the time of first anal exhaust after operation were recorded. The levels of gastrointestinal hormones, surgical-related factors and inflammatory factors were measured before and after operation. Results The recovery time of bowel sounds and the first time of anal exhaust in the Da Vinci operation group were shorter than those in the open operation group(both P<0.05). The motilin, gastrin, somatostatin levels at 24h after operation were significantly lower than those at 12h before operation in both groups(all P<0.05), the vasoactive intestinal peptide levels were significantly increased(P<0.05). At 24h after operation, the motilin and gastrin levels in the Da Vinci operation group were higher than those in the open operation group(both P<0.05); the levels of vasoactive intestinal peptide in the Da Vinci operation group were lower than those in the open operation group(P<0.05). In all patients, the recovery time of bowel sounds and the time of first anal exhaust were negatively correlated with the motilin and gastrin levels(P<0.05), while they were positively correlated with the levels of vasoactive intestinal peptide at 24h after operation(all P<0.05). There were significant differences in operative time, operative blood loss, drainage tube removal time, VAS pain grade and inflammatory factors between the two groups(all P<0.05). Conclusion The recovery of gastrointestinal motility of gastric cancer patients treated with Da Vinci surgery is significantly faster than that with traditional laparotomy. The inflammation and stress reaction caused by trauma may be the important factors affecting gastrointestinal hormone secretion.