腹腔镜与传统开腹手术对胃癌临床疗效、术后并发症及免疫功能的影响比较

目的:探讨腹腔镜与传统开腹手术治疗胃癌的临床疗效、安全性及对患者免疫功能的影响。方法:选择2012年3月至2014年3月在我院行胃癌D2根治术的胃癌患者92例并随机分为两组,开腹组(A组)44例接受传统开腹手术,腹腔镜组(B组)48例接受腹腔镜辅助胃癌根治术,观察和比较两组患者的手术情况以及手术前后患者免疫功能的变化,比较两组患者围术期不良反应的发生情况及临床疗效。结果:B组患者术中切口长度、出血量明显优于A组患者(P0.05),且B组患者较A组患者术后排气时间以及疼痛缓解情况明显较好(P0.05);两组患者接受手术前后,机体的免疫功能有所变化,B组患者术后24hCD3~+、CD4~+、CD8~+、CD4~+/CD8~+以及NK细胞相对活性等细胞免疫指标明显高于A组(P0.05),体液免疫指标IgM、IgG以及IgA等免疫球蛋白明显高于A组;两组患者术中并发症的发生率差异无统计学意义(P0.05),B组患者术后并发症的发生率与A组比较明显降低,且差异具有统计学意义(P0.05)。结论:腹腔镜辅助胃癌D2根治术对胃癌患者术中临床疗效有显著改善作用,可降低对机体免疫功能的影响并提高治疗的安全性。

Comparison of the Influence of Laparoscopic and Traditional Open Surgery on the Clinical Effect, Postoperative Complications and Immunologic Functions of Patients with Gastric Cancer

ABSTRACT Objective: To explore the influence of laparoscopic and traditional open surgery on the clinical effect, safety and im- mune function of patients with gastric cancer. Methods: 92 patients of gastric cancer undergoing D2 radical resection were enrolled in our hospital from March 2012 to March 2014, in which patients were randomly divided into two groups: Group A (n=44) accepted traditional open surgery and Group B (n=48) adopted laparoscopic surgery. The clinical of surgery curative and immunologic functions were evalu- ated, and the adverse reactions in perioperative period were recorded and compared. Results: The operative incision lengths and bleeding of Group B were superior to those of Group B (P<0.05), and the postoperative exhaust time of Group B was shorter than that of Group A, the pain relief of Group B was better than that of Group A(P<0.05). The CD3+, CD4+, CD8+, CD4+/CD8+ and NK cell relative activity of cell immunity index was higher in Group B than those of Group A; the fluid immunity index of IgM, IgG and IgA in Group B were higher than those of Group A(P<0.05); no significant difference was observed in the intraoperative complications between two groups (P>0.05), and the incidence of postoperative complications in Group B was lower than that of Group A. Conclusion: Laparoscopic assisted D2 radical gastrectomy significantly improved the clinical curative of gastric cancer, decreased the impact on immune function and enhance the safety.