【摘要】 目的探讨腹腔镜下胃癌根治术对老年患者胃肠功能、凝血功能的影响。方法依据手术方式将106例老年胃癌患者分为开腹组和腔镜组,每组53例,开腹组患者给予传统开腹胃癌根治术治疗,腔镜组患者给予腹腔镜下胃癌根治术治疗。比较两组患者的一般手术指标、胃肠功能指标、凝血功能指标[活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)和D-二聚体]、炎性反应指标[C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)]、肿瘤标志物[癌胚抗原(CEA)、糖类抗原19-9(CA19-9)]和术后并发症发生情况。结果腔镜组患者术中出血量明显少于开腹组(P﹤0.01),住院时间明显短于开腹组(P﹤0.01),饮食恢复时间、肠鸣音恢复时间、肛门排气时间、排便恢复时间均明显短于开腹组(P﹤0.01)。术后3天,两组患者血清APTT明显短于本组术前(P﹤0.01),FIB、D-二聚体水平明显高于本组术前(P﹤0.01),且腔镜组患者血清APTT明显长于开腹组,FIB、D-二聚体水平明显低于开腹组(P﹤0.01)。术后3天,两组患者血清CRP、TNF-α水平均明显高于本组术前(P﹤0.01),CEA、CA19-9水平均明显低于本组术前(P﹤0.01),且腔镜组患者CRP、TNF-α水平均明显低于开腹组(P﹤0.01)。腔镜组患者术后并发症总发生率为5.66%,低于开腹组患者的22.64%(P﹤0.05)。结论腹腔镜下胃癌根治术可达到传统开腹术的手术切除效果,且对老年胃癌患者术后胃肠功能、凝血功能、炎性反应影响更轻,手术安全性更高。更多还原

【Abstract】 Objective To explore the effect of laparoscopic radical gastric cancer surgery on gastrointestinal function and coagulation function in elderly patients. Method According to the operation method, 106 elderly patients with gastric caner were divided into open group and laparoscopy group, with 53 cases in each group. The patients in the open group were treated with traditional laparotomy gastric cancer, and the patients in the laparoscopy group were treated with laparoscopic radical gastric cancer. The general operation indexes, gastrointestinal function indexes, coagulation function indexes [activated partial thromboplastin time(APTT), fibrinogen(FIB) and D-dimer], inflammatory reaction indexes [Creactive protein(CRP) and tumor necrosis factor-α（TNF-α）], tumor markers [carcinoembryonic antigen(CEA), carbohydrate antigen 19-9(CA19-9)] and postoperative complications were compared between the two groups. Result The intraoperative blood loss of the patients in the laparoscopy group was significantly lower than that of the laparotomy group(P<0.01), and the hospital stay was significantly shorter than that of the laparotomy group(P<0.01), the recovery time of diet, bowel sounds, anal exhaust time, and defecation recovery time were significantly shorter In the open abdominal group(P<0.01). At 3 days after operation, the serum APTT of the two groups of patients was significantly shorter than that of the group before the operation, and the levels of FIB and D-dimer were significantly higher than those of the group before the operation(P<0.01), and the serum APTT of the patients in the laparoscopy group was significantly longer than that of the open group, FIB, D-dimer level was significantly lower than that of the open group(P<0.01). 3 days after operation,the serum CRP and TNF-α levels of the two groups were significantly higher than those of the group before the operation(P<0.01), and the levels of CEA and CA19-9 were significantly lower than those of the group before the operation(P<0.01), and the CRP and TNF-α levels of the patients in the endoscopy group were significantly lower than the open group(P<0.01). The total incidence of postoperative complications in the laparoscopy group was 5.66%, which was lower than22.64% in the open group(P<0.05). Conclusion Laparoscopic radical resection of gastric cancer can achieve the surgical resection effect of traditional laparotomy, and has less impact on gastrointestinal function, coagulation function, and inflammatory reaction in elderly patients with gastric cancer after surgery, and the surgical safety is higher.更多还原