腹腔镜与开腹远端胃癌根治术疗效及对凝血功能影响的对比研究

目的：对比腹腔镜与开腹远端胃癌根治术的疗效及对凝血功能的影响。方法选取行腹腔镜远端胃癌根治术的患者56例（观察组）及同期开腹远端胃癌根治术患者56例（对照组）。对两组患者的术中及术后情况、淋巴结清扫数目、并发症等进行比较分析，并检测比较两组患者术前、术后24h凝血酶原国际标准化值（INR）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、D-二聚体（D- D）以及纤维蛋白原（FIB）水平。结果观察组手术时间长于开腹组，而术中出血量、切口长度、术后首次肛门排气时间、术后镇痛药使用次数、住院时间均少于开腹组，差异均有统计学意义（均P＜0.01）。与手术前比较，仅观察组患者PT显著延长，差异有统计学意义（P＜0.05）；与对照组比较，观察组PT显著延长，差异有统计学意义（P＜0.05）。与术前相比，两组患者术后FIB及D- D体均明显增高，差异均有统计学意义（均P＜0.05）；观察组患者术后FIB及D- D较对照组明显增高，差异有统计学意义（P＜0.05）。观察组术后并发症发生率明显低于对照组（10.7%、14.3%），差异有统计学意义（P＜0.05）。结论腹腔镜远端胃癌根治术具有安全、术后恢复快等优点，且在淋巴结清扫方面能达到与开腹手术相同的效果，但其可导致患者处于高凝状态，可能发生血栓性并发症，应予以重视。

Comparison of laparoscopic assisted with open distal gastrectomy for patients with gastric cancer

Objective To compare the clinical effects between laparoscopic assistance and open distal gastrectomy for patients with gastric cancer. Methods Fifty six patients with gastric cancer underwent laparoscopic assistance distal gastrecto-my （group L） and 56 cases received open distal gastrectomy （group O） were included in the study.The intraoperative and post-operative information, the number of dissected lymph nodes, postoperative complications were compared between two groups. The prothrombin international normalized value（INR）, prothrombin time（PT）, activated partial thromboplastin time （APTT）, D- dimer and fibrinogen （FIB） levels were measured before and after operation in both groups. Results The operative time in group L was significantly longer than that in group O.However,the mean blood loss,the frequency of analgesics use after operation were less and first flatus time, total hospital stay were shorter in group L than those in group O （al P＆lt;0.01）.The postoperative prothrombin time（PT） was significantly increased than that before operation in group L（P＆lt;0.05）, and PT in group L was also significantly high-er than that in group O （P＆lt;0.05）. Compared with preoperative levels, D- dimer and fibrinogen （FIB） in both groups were signifi-cantly increased （P＆lt;0.05）;while the postoperative D- dimer and fibrinogen （FIB） levels in group L were significantly higher than those in group O （P＆lt;0.05）. The postoperative complications in group L were significantly lower than those in group O （10.7%vs 14.3%, P＆lt;0.05）. Conclusion Laparoscopic- assisted distal gastrectomy is a safe and feasible procedure, but it may lead to hy-percoagulative state and thrombotic diseases.