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目的探究腹腔镜D2根治全胃切除术治疗进展期患者的近期疗效。方法回顾性分析2012年5月至2015年5月在陕西省肿瘤医院就诊且因胃癌行全胃切除术的34例患者,根据手术方案的不同,将患者分为腹腔镜组(15例)和开腹组(19例)。对两组患者手术相关指标、术后恢复情况、手术前后患者免疫功能以及术后并发症进行比较分析。结果腹腔镜组患者手术时间为(269.7±52.4)min,开腹组为(238.5±48.7)min,两组比较差异有统计学意义(P<0.05)。腹腔镜组患者术中出血量为(93.7±34.5)ml,开腹组为(212.7±48.6)ml,两组比较差异有统计学意义(P<0.05)。手术结束后,开腹组患者术后肛门排气时间为(3.3±1.6)d,腹腔镜组为(2.6±1.5)d,腹腔镜组明显短于开腹组,差异有统计学意义(P<0.05)。开腹组患者术后进流质时间为(4.2±1.9)d,腹腔镜组为(3.7±1.2)d,差异有统计学意义(P<0.05)。开腹组患者术后下床时间为(4.5±3.0)d,腹腔镜组为(3.1±1.6)d,差异有统计学意义(P<0.05)。腹腔镜组患者术后住院时间为(10.7±9.2)d,开腹组为(12.1±3.4)d,两组差异有统计学意义(P<0.05)。术后第7天,开腹组患者CD_3~+、CD_4~+、CD_8~+和CD_4~+/CD_8~+指标分别为(41.01±4.17)%、(23.35±3.87)%、(16.87±4.18)%和(1.24±0.06)%。腹腔镜组患者CD_3~+、CD_4~+、CD_8~+和CD_4~+/CD_8~+指标分别为(48.98±5.21)%、(35.87±4.09)%、(22.08±4.36)%和(1.54±0.11)%,两组差异有统计学意义(P<0.05)。两组患者术后并发症发生率均为29.1%,差异有统计学意义(P<0.05)。结论进展期胃癌患者行腹腔镜D2根治全胃切除术治疗虽然手术时间较长,但是术后恢复情况较好,对患者免疫功能影响较小,而且不会提高术后并发症发生率。
Objective To investigate the short-term curative effect of laparoscopic D2 radical total gastrectomy in advanced patients. Methods A retrospective analysis was performed on 34 patients who underwent total gastrectomy for gastric cancer at the Cancer Hospital of Shaanxi Province from May 2012 to May 2015. According to the different surgical plans, the patients were divided into laparoscopic group (15 cases) and Open group (19 cases). Two groups of patients with surgery-related indicators, postoperative recovery, patients with immune function and postoperative complications were compared. Results The operation time was (269.7 ± 52.4) min in laparoscopic group and (238.5 ± 48.7) min in laparotomy group, the difference was statistically significant (P <0.05). The amount of bleeding in the laparoscopic group was (93.7 ± 34.5) ml and (212.7 ± 48.6) ml in the open group, respectively, with significant difference between the two groups (P <0.05). After operation, the time of postoperative anal exhaust in open group was (3.3 ± 1.6) d, (2.6 ± 1.5) d in laparoscopic group, and shorter in laparoscopic group than in open group (P <0.05). The difference was statistically significant (P <0.05). The open time was (4.2 ± 1.9) d in the open group and (3.7 ± 1.2) d in the laparoscopic group, the difference was statistically significant (P <0.05). The open time of the patients in the open group was (4.5 ± 3.0) days after operation and (3.1 ± 1.6) days in the laparoscopic group, the difference was statistically significant (P <0.05). The length of postoperative hospital stay was (10.7 ± 9.2) days in laparoscopic group and (12.1 ± 3.4) days in open group, with significant difference between the two groups (P <0.05). On day 7 after operation, the indexes of CD_3 ~ +, CD_4 ~ +, CD_8 ~ + and CD_4 ~ + / CD_8 ~ + were (41.01 ± 4.17)%, (23.35 ± 3.87)% and (16.87 ± 4.18 )% And (1.24 ± 0.06)%. The indexes of CD_3 ~ +, CD_4 ~ +, CD_8 ~ + and CD_4 ~ + / CD_8 ~ + in the laparoscopic group were (48.98 ± 5.21)%, (35.87 ± 4.09)%, (22.08 ± 4.36)% and 0.11)%, the difference between the two groups was statistically significant (P <0.05). Postoperative complications in both groups were 29.1%, the difference was statistically significant (P <0.05). Conclusions The treatment of radical gastrectomy with D2 laparoscopic radical gastrectomy in patients with advanced gastric cancer has a good postoperative recovery although the operation time is longer, which has less impact on immune function and does not increase the incidence of postoperative complications.