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目的比较腹腔镜辅助胃癌根治术与开腹胃癌根治术对机体急性期反应及细胞免疫功能的影响。方法回顾性分析2014年9月-2015年9月于本院普通外科住院手术治疗的179例胃癌患者临床病理资料。腹腔镜组82例,开腹组97例,两组资料具有可比性(P>0.05)。比较两组术前1 d,术后1 d、2 d、3 d、7 d外周血C-反应蛋白(C-reactive protein,CRP)、白细胞介素-6(interleukin-6,IL-6)浓度及淋巴细胞计数、中性粒细胞计数、中性粒细胞计数/淋巴细胞计数水平。结果与开腹组相比,腹腔镜组术中出血量少[(152.32±98.18)ml vs(238.97±138.03)ml,P<0.05],手术时间略长[(211.44±54.58)min vs(191.32±50.15)min,P<0.05],淋巴结清扫数目相近[(25.26±1.44)vs(24.97±1.94),P>0.05]。两组CRP、IL-6水平及中性粒细胞计数、淋巴细胞计数、中性粒细胞计数/淋巴细胞计数均在正常范围内,无统计学差异(P均>0.05)。两组CRP、IL-6术后1 d、2 d、3 d、7 d均较术前明显升高(P<0.05);CRP在术后第2天达到峰值,IL-6在术后第1天达到峰值;术后同一时点,腹腔镜组CRP,IL-6水平均低于开腹组(P<0.05)。两组中性粒细胞计数、中性粒细胞计数/淋巴细胞计数比值术后第1、2、3、7天均较术前明显升高(P<0.05),淋巴细胞计数较术前明显下降(P<0.05);中性粒细胞计数、中性粒细胞计数/淋巴细胞计数在术后第1天达到峰值,淋巴细胞计数在术后第1天降到最小值;术后同一时点,腹腔镜组中性粒细胞计数、中性粒细胞计数/淋巴细胞计数低于开腹组,淋巴细胞计数则高于开腹组(P<0.05)。结论腹腔镜手术与开腹手术相比,术中出血量少,手术效果相近,手术时间稍长,引起的急性期反应及细胞免疫抑制程度轻。
Objective To compare the effects of laparoscopic-assisted radical gastrectomy and laparoscopic radical gastrectomy on acute phase response and cellular immune function. Methods The clinicopathological data of 179 patients with gastric cancer undergoing general surgery in our hospital from September 2014 to September 2015 were retrospectively analyzed. 82 cases of laparoscopic group, 97 cases of open group, the two groups of data was comparable (P> 0.05). The levels of C-reactive protein (CRP), interleukin-6 (IL-6) and interleukin-6 (IL-6) in the peripheral blood were measured at 1 d, 2 d, Concentration and lymphocyte count, neutrophil count, neutrophil count / lymphocyte count levels. Results Compared with the open group, laparoscopic group had less blood loss (152.32 ± 98.18) ml vs (238.97 ± 138.03) ml, P <0.05, and slightly longer operative time (211.44 ± 54.58) min vs (191.32 ± 50.15) min, P <0.05]. The number of lymph node dissection was similar [(25.26 ± 1.44) vs (24.97 ± 1.94), P> 0.05]. CRP, IL-6 levels and neutrophil count, lymphocyte count, neutrophil count / lymphocyte count in the two groups were within the normal range, no statistical difference (P all> 0.05). The levels of CRP and IL-6 in the two groups were significantly higher at 1, 2, 3 and 7 days after operation (P <0.05); CRP peaked at 2 days after operation, 1 day peaked; at the same time after surgery, the levels of CRP and IL-6 in laparoscopic group were lower than those in laparotomy group (P <0.05). The neutrophil count / neutrophil count / lymphocyte count ratio of the two groups were significantly higher than those preoperatively (P <0.05) at 1, 2, 3 and 7 days after operation, and the lymphocyte count was significantly lower than that before operation (P <0.05). The neutrophil count, neutrophil count / lymphocyte count peaked on the first postoperative day, and the lymphocyte count decreased to a minimum on the first postoperative day. At the same time point after the operation, Neutrophil count, neutrophil count / lymphocyte count in laparoscopic group were lower than those in open group, and lymphocyte count was higher in laparoscopic group than in open group (P <0.05). Conclusions Compared with laparotomy, laparoscopic surgery has less intraoperative blood loss, similar operative results, longer operation time, and less acute phase reaction and less cellular immunosuppression.