摘要
目的:探讨腹腔镜胃癌根治术对患者免疫功能、凝血功能的影响及其预后影响因素。方法:收集2016年5月至2018年5月就诊于河南省人民医院经腹腔镜胃癌根治术治疗的58例患者(腹腔镜组)和经传统开腹治疗的40例患者(传统组)的临床资料。腹腔镜组患者行腹腔镜胃癌根治术,传统组患者行开腹胃癌根治手术,比较两组患者术前及术后的免疫功能和凝血功能,分析腹腔镜胃癌根治术患者的预后及其影响因素。结果:术后3 d,腹腔镜组CD4^+水平、CD4^+/CD8^+分别为(29.78±3.58)%和1.01±0.18,均高于对照组[分别为(27.23±3.47)%和0.93±0.14],差异均有统计学意义(均P<0.05)。腹腔镜组和传统组患者的活化部分凝血酶原时间分别为(26.55±2.56)s和(27.86±2.73)s,纤维蛋白原水平分别为(4.24±0.84)g/L和(3.88±0.75)g/L,D-二聚体水平分别为(377.91±47.19)μg/L和(330.28±45.11)μg/L,差异均有统计学意义(均P<0.05)。传统组和腹腔镜组患者的5年生存率分别为77.5%和72.4%,差异无统计学意义(P>0.05)。多因素分析显示,淋巴结转移为影响腹腔镜胃癌根治术患者预后的独立影响因素(P<0.05)。结论:腹腔镜胃癌根治术可有效减轻患者术后的免疫功能抑制,但机体易处于高凝状态,淋巴结转移与胃癌患者的预后有关。术前、术后应全面评估患者的病情以制定合理的治疗方案,减少术后并发症的发生。
Objective To explore the influence of laparoscopic radical gastrectomy on patients′immune functions,coagulation functions and prognoses.Methods Fifty-eight patients with gastric cancer who underwent laparoscopic radical gastrectomy(laparoscopic group)and 40 patients with gastric cancer who underwent traditional open surgery(traditional group)in Henan People′s Hospital from May 2016 to May 2018 were selected as the subjects.The immune function and coagulation function were compared between the two groups before and after operation.The prognoses of patients underwent laparoscopic radical gastrectomy and the influencing factors were analyzed.Results Three days after operation,the CD4^+ level and CD4^+/CD8^+ ratio in laparoscopic group were(29.78±3.58)% and(1.01±0.18),higher than(27.23±3.47)% and(0.93±0.14)in control group(P<0.05).Three days after operation,the activated partial thromboplastin time(APTT)in laparoscopic group was(26.55±2.56)seconds,shorter than(27.86±2.73)seconds in traditional group,while the levels of fibrinogen(FIB)and D-dimer were(4.24±0.84)g/L and(377.91±47.19)μg/L,higher than(3.88±0.75)g/L and(330.28±45.11)μg/L in traditional group(P<0.05).The 5-year survival rate was 77.5%in traditional group and 72.4% in laparoscopic group,without significant difference(P>0.05).Multivariate analysis showed that lymph node metastasis was the independent risk factor for prognosis of laparoscopic radical gastrectomy(P<0.05).Conclusions Laparoscopic radical gastrectomy can effectively reduce postoperative immunosuppression,but affect postoperative coagulation function.Lymph node metastasis is closely related to the prognosis of patient with gastric cancer.The patient's condition should be comprehensively evaluated before and after operation to determine whether the laparoscopic operation is suitable,for reducing postoperative complications and improving the prognosis.
作者
谷军保
鲍学斌
马钊
Gu Junbao;Bao Xuebin;Ma Zhao(Department of Gastrointestinal Surgery,People's Hospital of Zhengzhou University,Henan People's Hospital,Zhengzhou 450000,China)
出处
《中华肿瘤杂志》
CAS
CSCD
北大核心
2020年第7期598-602,共5页
Chinese Journal of Oncology
关键词
胃肿瘤
腹腔镜胃癌根治术
免疫功能
凝血功能
预后
Gastric neoplasms
Laparoscopic radical gastrectomy
Immune function
Coagulation function
Prognosis
