目的 探讨腹腔镜辅助远端胃癌根治术(laparoscopy-assisted distal gastrectomy,LADG)对老年进展期胃癌的短期疗效。方法 分别选取128例行LADG和128例传统开腹术的老年胃癌患者,比较两组患者的术中及术后指标、白细胞计数(WBC)、C反应蛋白(CRP)、血浆胃动素、血管活性肠肽和生长抑素,并统计患者的术后并发症。结果 腹腔镜组的术中出血量、手术切口、肛门首次排气时间等术后指标显著低于开腹组,差异有统计学意义(P＜0.05)。两组患者的WBC和CRP值有随时间变化的趋势(P＜0.05);腹腔镜组患者在术后不同阶段的WBC和CRP值显著低于开腹组,差异有统计学意义(P＜0.05);不同手术方式与时间的交互效应对WBC和CRP值有影响(P＜0.05)。两组患者的血浆胃动素、血管活性肠肽和生长抑素有随时间变化的趋势(P＜0.05),腹腔镜组患者术后不同阶段的血浆胃动素值显著高于开腹组,而血管活性肠肽和生长抑素值显著低于开腹组,差异有统计学意义(P＜0.05),不同手术方式与时间的交互效应对血浆胃动素、血管活性肠肽和生长抑素有影响(P＜0.05)。两组患者并发症发生率比较,差异无统计学意义。结论 LADG在减少术中出血量、减小手术切口、缩短住院时间、降低机体炎性反应、促进胃肠功能恢复等方面具有明显的优势。

Objective To investigate the short-term effect of laparoscopy-assisted distal gastrectomy(LADG)for elder gastric cancer patients at the progressive stage.Methods One hundred and twenty-eight patients with gastric cancer who had undergone LADG and another 128 patients treated with traditional open abdominal surgery were compared in terms of intraoperative and postoperative indexes, leukocyte count, C reactive protein, plasma motilin, vasoactive intestinal peptide and somatostatin.Results The amount of intraoperative bleeding, size of surgical incision, and the first anus exhaust time in the laparoscopy group were significantly smaller or earlier than those in the laparotomy group(P<0.05). WBC and CRP values of the two groups changed with time (P<0.05), and were significantly lower in the laparoscopic group than in the laparotomy group (P<0.05) at different stages. The interactions between different surgical methods and time had effect on the values of WBC and CRP (P<0.05). The plasma motilin, vasoactive intestinal peptide and somatostatin in the two groups changed with time (P<0.05). The values of plasma motilin in the laparoscopic group were significantly higher than those in the laparotomy group at different stages, while the values of vasoactive intestinal peptide and somatostatin were significantly lower (P<0.05). The interactions between surgical approaches and time had some effect on plasma motilin, vasoactive intestinal peptide and somatostatin (P<0.05). There was no significant difference in complications between the two groups, P>0.05.Conclusions LADG has obvious advantages in reducing the amount of bleeding, surgical incision, hospital stay and inflammatory responses, and in promoting the recovery of gastrointestinal function.