腹腔镜辅助与开腹胃癌根治术临床效果及对肠道屏障功能影响的比较

目的:比较腹腔镜胃癌根治术与传统开腹胃癌根治术对患者临床指标及术后肠道屏障功能的影响。方法:选择2016年1月—2016年6月符合条件的41例胃癌患者,其中21例行腹腔镜辅助胃癌D_2根治术(腔镜组),20例行开腹胃癌D_2根治术(开腹组)。比较两组患者相关临床指标及手术前后血浆二胺氧化酶(DAO)和内毒素(ETX)水平的变化。结果:两组患者的基本临床资料具有可比性。腔镜组手术切口长度、术中出血量均优于开腹组,但手术时间长于开腹组(均P0.05),其他临床指标包括术中输血比例、清扫淋巴结数量、手术切缘、术后通气时间两组间差异无统计学意义(均P0.05)。两组患者术后第1天DAO和ETX水平均较术前明显升高(均P0.05),但随后均将至术前水平,两组术前与术后各时间点DAO和ETX水平差异均无统计学意义(均P0.05),且DAO和ETX水平在两组患者中均呈正相关(r=0.759、r=0.559,均P0.05)。两组感染性并发症发生率无统计学差异(P0.05)。结论:腹腔镜辅助胃癌根治术与传统开腹胃癌根治术同样安全、有效,且对肠道屏障功能影响无明显增加。

Laparoscopic-assisted versus open radical gastrectomy for gastric cancer: comparison of clinical effects and influence on intestinal barrier function

Objective: To compare the clinical effects and influences on postoperative intestinal barrier function between laparoscopic-assisted and traditional open radical gastrectomy for gastric cancer. Methods: Forty-one eligible patients with gastric cancer from January 2016 to June 2016 were enrolled. Of the patients, 21 cases underwent laparoscopic-assisted D2 radical gastrectomy (laparoscopic group), and 20 cases underwent open D2 radical surgery (laparotomy group). The main clinical variables and changes in the plasma concentrations of diamine oxidase (DAO) and endotoxin (ETX) before and after operation between the two groups of patients were compared. Results: The general clinical data of the two groups of patients were comparable. Laparoscopic group was superior to laparotomy group in terms of incision length and intraoperative blood loss, but its operative time was longer than that in laparotomy group (all P<0.05), while, no significant difference was noted in other clinical variables that included intraoperative blood infusion requirements, number of lymph node resection, surgical margins and time to postoperative gas passage between the two groups of patients (all P>0.05). The plasma levels of DAO and ETX were significantly increased in both groups on postoperative day one compared with their preoperative levels (all P<0.05), but all returned to their preoperative levels later, and the DAO and ETX levels showed no significant difference between the two group before operation and at any observed time point after operation (all P>0.05). Further, there was a positive correlation betweern DAO and ETX levels in either group of patients (r=0.759; r=0.559, both P<0.05). The incidence of infectious complications showed no significant difference between the two groups (P>0.05). Conclusion: Laparoscopic-assisted radical gastrectomy is as safe and effective as traditional open radical gastrectomy, and it also does not increase the impact on intestinal barrier function.