腹腔镜远端与腹腔镜辅助远端胃癌根治术对胃癌患者的影响比较

Comparison of the effects of totally laparoscopic distal gastrectomy and laparoscopy-assisted distal gastrectomy on patients with gastric cancer

摘要:

目的 探讨全腹腔镜远端胃癌根治术（TLDG）与腹腔镜辅助远端胃癌根治术（LADG）对胃癌患者的影响。方法 选取2020年1月—2024年3月商洛市中心医院胃肠外科接收的100例胃癌患者，按手术方法分为LADG组（48例）和TLDG组（52例）。LADG组给予LADG治疗，TLDG组给予TLDG治疗。比较两组围手术期指标、视觉模拟评分量表（VAS）、免疫功能、生活质量及并发症。结果 TLDG组行走恢复时间、首次排气时间和首次进食时间均短于LADG组（P <0.05）。LDG组与LADG组手术时间、术中出血量比较，差异均无统计学意义（P >0.05）。两组术后1、3、7 d VAS评分比较，经重复测量设计的方差分析，结果 ①不同时间点VAS评分比较，差异有统计学意义（P <0.05）；②两组VAS评分比较，差异有统计学意义（P <0.05），TLDG组VAS评分较低，相对镇痛效果较好；③两组VAS评分变化趋势比较，差异无统计学意义（P >0.05）。TLDG组治疗前后CD3⁺、CD4⁺、白细胞计数、中性白细胞计数的差值均高于LADG组（P <0.05）。TLDG组治疗前后生理机能、生理职能、躯体疼痛、一般健康状况、精力、社会功能、情感职能、精神健康评分的差值均高于LADG组（P <0.05）。两组并发症总发生率比较，差异无统计学意义（P >0.05）。结论 TLDG治疗对胃癌患者手术近期疗效和免疫功能的影响比LADG更为显著。

Abstract:

Objective To compare the effects of totally laparoscopic distal gastrectomy (TLDG) and laparoscopy-assisted distal gastrectomy (LADG) on patients with gastric cancer.Methods From January 2020 to March 2024, a total of 100 gastric cancer patients admitted to the Department of Gastrointestinal Surgery at Shangluo Central Hospital were selected. They were divided into the LADG group (n = 48) and the TLDG group (n = 52) based on the surgical method. The LADG group received LADG treatment, while the TLDG group received TLDG treatment. The perioperative indicators, Visual Analog Scale (VAS) scores, immune function, quality of life, and complications were compared between the two groups.Results In the TLDG group, the time to postoperative ambulation, time to first flatus, and time to oral intake were all significantly shorter than those in the LADG group (P < 0.05). There was no difference in terms of the operative duration or intraoperative bleeding between the TLDG group and the LADG group (P > 0.05). VAS scores at 1, 3, and 7 days postoperatively in the two groups were compared using repeated measures ANOVA, which demonstrated that they were different among the time points (P < 0.05) and between the groups (P < 0.05). The VAS scores in the TLDG group were lower, indicating better analgesic effects. There was no difference in the change trends of VAS scores between the two groups (P > 0.05). The differences in CD3⁺, CD4⁺, white blood cell count, and neutrophil count before and after treatment in the TLDG group were higher than those in the LADG group (P < 0.05). The differences in SF-36 scores for physical functioning, physical role functioning, bodily pain, general health perceptions, vitality, social role functioning, emotional role functioning, and mental health before and after treatment in the TLDG group were also higher than those in the LADG group (P < 0.05). The overall incidence of complications did not differ significantly between the TLDG and the LADG groups (P > 0.05).Conclusions TLDG treatment has a greater impact on short-term therapeutic efficacy and immune function in patients with gastric cancer compared to LADG.