天津医药

天津医药 ›› 2015, Vol. 43 ›› Issue (3): 274-277.doi: 10.11958/j.issn.0253-9896.2015.03.014

• 临床研究 • 上一篇    下一篇

腹腔镜胃癌根治术后患者炎症因子及凝血功能变化的研究

鲁力， 谢敏， 熊治国   

  1. 武汉， 湖北省肿瘤医院胃肠外科(邮编430071)
  • 收稿日期:2014-07-10 修回日期:2014-08-26 出版日期:2015-03-15 发布日期:2015-03-15
  • 通讯作者: 熊治国 E-mail:1790946193@qq.com
  • 作者简介: 鲁力 （1978）， 男， 博士， 主要从事消化道肿瘤研究
  • 基金资助:
    湖北省自然科学基金资助项目 （2013CFC023）

Researches on inflammatory factor and blood coagulation in patients with laparoscopic gastric cancer radical surgery

LU Li, XIE Min, XIONG Zhiguo   

  1. Hubei Cancer Hospital, Wuhan 430071, China
  • Received:2014-07-10 Revised:2014-08-26 Published:2015-03-15 Online:2015-03-15
  • Contact: XIONG Zhiguo E-mail:1790946193@qq.com

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摘要： 目的 探讨腹腔镜胃癌根治术后患者炎症因子及凝血功能的变化。方法 回顾性分析 2012 年 6 月— 2014 年 6 月在我院行胃癌治疗的 77 例患者， 其中 38 例予以腹腔镜治疗 （腹腔镜组）， 39 例予以常规开腹治疗 （开腹组）。分析比较 2 组患者术前、 术后 6 h、 术后 24 h 的白介素 （IL） -6、 IL-8、 肿瘤坏死因子-α（TNF-α）、 血清活化部分凝血活酶时间 （APTT）、 凝血酶原时间 （PT）、 国际标准化比值 （INR）、 纤维蛋白原 （FIB）、 D 二聚体 （D-D） 的水平变化情况； 统计并比较 2 组患者术后血栓发生例数及肿瘤复发情况。结果 2 组患者在性别、 年龄、 肿瘤大小、 分化程度及 TNM 分期上的差异均无统计学意义， 具有可比性。术后 2 组患者血清 IL-6、 IL-8、 TNF-α水平与术前相比均明显升高 （P＜0.01）， 且开腹组高于腹腔镜组 （P＜0.01）。术后 2 组患者 APTT、 PT、 INR 水平较术前明显降低， 且腹腔镜组低于开腹组 （P＜0.05）； 2 组患者术后 FIB、 D-D 水平较术前明显升高(P＜0.05),且腹腔镜组高于开腹组 （P＜0.05）； 腹腔镜组患者术后肿瘤复发例数少于开腹组， 但术后血栓性疾病发生例数则多于开腹组。结论 腹腔镜胃癌根治术后患者炎症介质释放减少， 对机体的免疫功能影响较小， 但其对患者的凝血功能影响较大， 临床治疗时应加以注意。

关键词: 胃肿瘤, 腹腔镜检查, 开腹手术, 胃癌根治术, 炎症因子, 凝血功能

Abstract: Objective To investigate the change of inflammatory factor and blood coagulation in patients with laparo⁃ scopic gastric cancer radical surgery. Methods Data of seventy-seven stomach cancer patients hospitalized in our hospital and received the surgical treatment from June 2012 to June 2014 were retrospectively analyzed. Thirty-eight of these pa⁃ tients underwent laparoscopic treatment (laparoscopic group) and 39 cases received laparotomy treatment (laparotomy group). The values of interleukin-6 (IL-6), IL-8 and tumor necrosis factor alpha (TNF-α) were analyzed at the time points of preop⁃ eration and 6 h, 24 h after the surgery in two groups. The levels of activated partial thromboplastin time (APTT), prothrombin time (PT), international standardization ration (INR), fibrinogen (FIB) and D dimer (D-D) were also analyzed at the same time points in two groups. The postoperative thrombosis and tumor recurrence rate were also analyzed in two groups of pa⁃ tients. Results There were no significant differences in the gender, age, the size of tumor, differentiation degree and TNM staging between two groups of patients. The serum levels of IL-6, IL-8 and TNF-α were significantly increased after surgery in two groups (P ＜ 0.01), and which were significantly higher in laparotomy group than those of laparoscopic group (P＜ 0.01). The levels of APTT, PT and INR were significantly lower after surgery in two groups of patients, and which were signifi⁃ cantly lower in laparoscopic group than those of laparotomy group (P＜0.05). The levels of FIB and D-D were significantly increased after operation in two groups of patients (P＜0.05), which were significantly higher in laparoscopic group than those of laparotomy group (P＜0.05). The postoperative recurrence of cancer was less in laparoscopic group than that of lapa⁃ rotomy group. But, the postoperative thrombosis was more in laparoscopic group than that of laparotomy group. Conclusion There was less release of inflammatory mediators and less effect on the body’ s immune function in patients with laparoscopic gastric cancer radical surgery. But, the surgery has a large influence in blood coagulation, we should pay attention to it in the clinical treatment.

Key words: stomach neoplasms, laparoscopy, laparotomy, gastric cancer radical gastrectomy, inflammatory factor , blood coagulation function