胃癌不同术式对肠道屏障功能的影响对比

刘鹏 佘小琛

[摘要]目的 探究兩种不同胃癌根治术对患者肠道屏障功能的影响。方法 从2012年1月～2017年12月我院外科及内科收治的胃癌患者中选出80例，根据手术方法不同分成开腹组（40例）和腹腔镜组（40例），比较两组的手术时间、肠道功能恢复时间、肠鸣音恢复时间、首次排气时间等。结果 腹腔镜组的手术时间明显长于开腹组，差异有统计学意义（P<0.05）；腹腔镜组的肠道功能恢复时间、肠鸣音恢复时间、首次排气时间、首次排便时间、进食时间以及术后恶心呕吐症状持续时间均短于开腹组，差异均有统计学意义（P<0.05）。术后3、5 d，腹腔镜组二胺氧化酶（DAO）水平和D-乳酸水平均低于开腹组，差异有统计学意义（P<0.05）；术后7 d两组间DAO水平和D-乳酸水平差异无统计学意义（P>0.05）。结论 胃癌根治术对患者的肠道屏障功能造成一定干扰，其中腹腔镜手术对患者肠道屏障的干扰较小，术后肠道屏障功能恢复较快，虽然腹腔镜手术时间偏长，但患者术后恢复较快，有广阔的应用推广价值。

[关键词]胃癌；腹腔镜手术；开腹手术；肠道屏障功能

[中图分类号] R735.2 [文献标识码] A [文章编号] 1674-4721（2018）5（b）-0075-04

Comparison of the effects of different surgical methods on the intestinal barrier function of gastric cancer

LIU Peng SHE Xiao-chen

Department of General Surgery，Huidong Hospital Affiliated to Guangdong Medical College，Guangdong Province，Huidong 516300，China

[Abstract]Objective To explore the effect of two different radical gastrectomy on the intestinal barrier function of the patients.Methods All of 80 cases were selected from January 2012 to December 2017 in our hospital and medicine from gastric cancer patients，divided into laparotomy group according to the different surgical methods （40 cases） and laparoscopic group （40 cases），the operation time，with intestinal function recovery time，recovery time of bowel sounds，the first exhaust time.were compared between twu groups.Results The operative time of laparoscopic group was significantly longer than that in the laparotomy group，the difference was statistically significant（P<0.05）；laparoscopic group the intestinal function recovery time，recovery time of bowel sounds，the first exhaust time，first defecation time，eating time and postoperative nausea and vomiting symptom duration was shorter than that in the laparotomy group，the differences were statistically significant （P<0.05）.3 and 5 d after operation，the DAO level and D-lactic acid level in the laparoscopic group were lower than those in the laparotomy group （P<0.05）.There was no significant difference in DAO level and D-lactate level between the two groups after 7 d，and the differences were not statistically significant （P>0.05）.Conclusions Radical resection of gastric cancer will cause some interference on the intestinal barrier function of patients，including laparoscopic surgery on patients with intestinal barrier interference，postoperative recovery of intestinal barrier function rapidly，although laparoscopic surgery time is too long，but with faster postoperative recovery，has broad application value.

[Key words]Gastric cancer；Laparoscopy；Laparotomy；Intestinal barrier function

胃癌是消化系统常见恶性肿瘤，其死亡率和发病率居恶性肿瘤的第2位，是危及到人类生命健康的重大疾病。胃癌的诱发因素较多，手术是主要的治疗方法，根治术是治愈胃癌的唯一途径[1-3]。伴随着内镜技术的发展，腹腔镜下胃癌根治术得到广泛推广与应用，已有不少学者报道指出相较于传统的开腹胃癌根治术，腹腔镜胃癌根治术能达到与之相当的疗效，并减轻手术创伤，促进患者术后的康复[4-5]，但是关于手术方式与患者肠道屏障功能关系的研究还不多。肠道屏障是阻止癌细胞、抗原物质、有毒物质、致病菌等进入体循环的屏障，是保障机体安全的一道重要屏障[6-7]。本研究旨在探究开腹手术和腹腔镜手术对胃癌患者肠道屏障功能的影响，为临床医生选择手术方式提供更多的依据，现报道如下。……