目的 探讨腹腔镜与开腹根治术对进展期胃癌患者机体炎症反应、免疫功能及疼痛因子的影响。 方法 选取2019 年6 月—2020 年6 月诸暨市人民医院收治的进展期胃癌患者86 例，按照手术方法不同分为腹 腔镜组和开腹组，各43 例。腹腔镜组采用全腹腔镜根治术治疗，开腹组采用开腹胃癌根治术治疗。比较两 组手术指标和术后并发症，术前和术后3 d 炎症反应［C 反应蛋白（CRP） 和白细胞介素-6 （IL-6）］、免 疫功能［CD3 +、CD4 +和CD4 +/CD8 +］ 和疼痛因子［5-羟色胺（5-HT）、P 物质（SP） 和去甲肾上腺素 （NE）］ 的变化。结果 开腹组术中出血量多于腹腔镜组（P <0.05），开腹组胃肠道恢复时间、手术时间长 于腹腔镜组（P <0.05）。开腹组术后并发症发生率高于腹腔镜组（P <0.05）。开腹组手术前后血清CRP、 IL-6 的差值大于腹腔镜组（P <0.05）。开腹组手术前后血清CD3 +、CD4 +和CD4 +/CD8 +的差值大于腹腔镜组 （P <0.05）。开腹组手术前后血清5-HT、SP 和NE 的差值大于腹腔镜组（P <0.05）。结论 腹腔镜根治术治 疗进展期胃癌患者术后并发症少，胃肠功能恢复快，对机体炎症反应、免疫功能和疼痛因子影响较小。
Objective To compare the effects of laparoscopic and open radical gastrectomy on inflammatory response, immune function and pain mediators in patients with advanced gastric cancer. Methods The 86 patients with advanced gastric cancer in our hospital from June 2019 to June 2020 were selected and divided into laparoscopic group (n = 43) and open group (n = 43) according to different surgical methods. The laparoscopic group was treated with laparoscopic surgery, while the open group was treated with open surgery. Then we compared the surgery-related indicators and complications, and the changes in inflammatory response [C-reactive protein (CRP) and interleukin-6 (IL-6)], immune function [CD3+ cell count, CD4+ cell count and CD4+/CD8+ ratio] and pain mediators [5-hydroxytryptamine (5-HT), substance P (SP) and norepinephrine (NE)] before and 3 days after the surgery between the two groups. Results The intraoperative blood loss in the open group was more than that in the laparoscopic group (P < 0.05). The recovery time of gastrointestinal tract and the operation time in open group were both longer than those in laparoscopic group (P < 0.05). The incidence of postoperative complications in open group was higher than that in laparoscopic group (P < 0.05). The differences of serum CRP and IL-6 before and after operation were higher in open group (P < 0.05); the differences of CD3+ cell count, CD4+ cell count and CD4+/CD8+ ratio before and after operation were greater in laparoscopic group (P < 0.05); while the differences of serum 5-HT, SP and NE before and after operation were higher in open group (P < 0.05). Conclusion Laparoscopic radical gastrectomy for advanced gastric cancer contributes to fewer postoperative complications and faster recovery of gastrointestinal function, and has less impact on inflammatory response, immune function and pain mediators.