【摘要】 目的 分析不同入路腹腔镜胃癌根治术（LG）对胃癌患者胃肠功能障碍及肿瘤标志物水平的影响。方法 以2020年1月-2022年6月天津市宝坻区人民医院行LG治疗的100例胃癌患者为研究对象，按照随机数字表法分为前入路组（50例）与后入路组（50例）。前入路组选择右侧前入路LG方案，后入路组则采用左侧后入路LG方案，比较两组手术指标（手术时间、术中出血量、淋巴结清扫数目）、术后胃肠恢复指标（肠鸣音恢复时间、排气时间、进食恢复时间）、胃肠功能障碍[胃肠道症状评定量表（GSRS）]、肿瘤标志物水平[癌胚抗原（CEA）、糖类抗原125(CA125)、糖类抗原19-9(CA19-9)]、术后并发症发生率。结果前入路组手术时间短于后入路组，术中出血量少于后入路组，淋巴结清扫数目大于后入路组（P<0.05）；前入路组肠鸣音恢复时间、排气时间、进食恢复时间短于后入路组，且术后GSRS评分低于后入路组（P<0.05）；两组术后CEA、CA125、CA19-9水平均低于术前，且前入路组CEA、CA125、CA19-9水平低于后入路组（P<0.05）；两组术后并发症发生率比较，差异无统计学意义（P>0.05）。结论 相较于左侧后入路，经右侧前入路行LG治疗手术时间更短、术中出血更少、淋巴清扫效果更好，可有效改善患者的胃肠功能障碍，缩短其胃肠道恢复时间，并降低其血清肿瘤标志物水平，二者手术并发症风险相似。更多还原

【Abstract】 Objective To analyze the effects of different approaches of laparoscopic radical gastrectomy(LG) on gastrointestinal dysfunction and tumor markers in patients with gastric cancer.Methods A total of 100 patients with gastric cancer who underwent LG treatment in Tianjin Baodi District People’s Hospital from January 2020 to June 2022 were divided into anterior approach group(50 patients) and posterior approach group(50 patients)according to the random number table method. The right anterior approach LG scheme was selected in the anterior approach group, and the left posterior approach LG scheme was used in the posterior approach group. The surgical indicators(operation time, intraoperative blood loss, number of lymph node dissection), postoperative gastrointestinal recovery indicators(bowel sound recovery time, exhaust time, eating recovery time),gastrointestinal dysfunction [gastrointestinal symptom rating scale(GSRS)], tumor marker levels [carcinoembryonic antigen(CEA), carbohydrate antigen125(CA125), carbohydrate antigen 19-9(CA19-9)], and the incidence of postoperative complications were compared between the two groups. Results The operation time of the anterior approach group was shorter than that of the posterior approach group, the intraoperative blood loss was less than that of the posterior approach group, and the number of lymph node dissection was greater than that of the posterior approach group( P<0.05). The recovery time of bowel sounds, exhaust time and eating recovery time in the anterior approach group were shorter than those in the posterior approach group, and the postoperative GSRS score was lower than that in the posterior approach group(P<0.05). The levels of CEA, CA125 and CA19-9 in the two groups were lower than those before operation, and the levels of CEA, CA125 and CA19-9 in the anterior approach group were lower than those in the posterior approach group(P<0.05). There was no significant difference in the incidence of postoperative complications between the two groups(P >0.05).Conclusion Compared with the left posterior approach, the operation time of LG via the right anterior approach is shorter, the intraoperative bleeding is less, and the lymph node dissection effect is better, which can significantly improve the gastrointestinal dysfunction of patients, shorten their gastrointestinal recovery time, and reduce their serum tumor marker levels. While, the risk of surgical complications is similar between the two approaches.更多还原