摘要
背景目前我国胃癌(gastric cancer, GC)的发病率较高且呈逐年上升的趋势,且对GC患者最有效的治疗手段就是胃大部切除或者胃全切,那么患者术中就要面临消化道重建的问题.随着腔镜技术的不断发展, GC患者术中使用腔镜技术进行消化道重建已经十分常见.但是对于腔镜辅助消化道重建是否能达到传统消化道重建的疗效,并不十分确切,故针对腔镜辅助消化道重建的疗效做出研究.目的探讨腹腔镜辅助消化道重建对GC患者的应用及患者Cyclin D1蛋白表达的影响.方法选取2015-05/2018-05天津市第五中心医院收治的行择期腹腔镜下全胃切除术的GC患者120例,随机分为两组,各组60例,研究组应用"P"形空肠袢空肠食管Roux-en-Y吻合术进行消化道重建,对照组应用空肠食管Roux-en-Y吻合术治疗.将两组患者手术时间、术中出血量、术后患者营养状况、并发症发生率以及CyclinD1蛋白表达情况进行对比.从而探究腹腔镜辅助消化道重建对GC患者的应用及其临床价值.结果两组患者术中出血量无差异(P>0.05),就手术时间、肠功能恢复时间方面,研究组低于对照组(P <0.05);研究组患者白蛋白、总蛋白、血红蛋白水平皆高于对照组(P<0.05);研究组上腹饱胀的发生率与倾倒综合征发生率较对照组(P<0.05),而腹泻、反流性食管炎、吻合口狭窄、吻合口出血以及肺部感染发生率两组间无明显差异(P>0.05);两组患者术后7 d,检测CyclinD1蛋白表达,所有患者皆为阴性,两组间无明显差异(P>0.05).结论全GC切除术后进行腹腔镜下消化道重建,有利于患者消化功能的恢复,提高患者术后营养水平,且不增加CyclinD1蛋白表达水平,临床上应当进一步推广应用.
BACKGROUND At present, the incidence of gastric cancer(GC) in China is high and has been increasing year by year. Since the most effective treatment for GC patients is partial or total resection of the stomach, GC patients often require reconstruction of the digestive tract during surgery. With the continuous development of endoscopic techniques, it is very common to use gastroscopic techniques for reconstruction of the digestive tract in patients with GC. However, it is not very clear whether laparoscopic assisted digestive tract reconstruction can achieve the same efficacy as traditional digestive tract reconstruction.AIM To investigate the therapeutic efficacy of laparoscopic assisted gastrointestinal reconstruction in GC patients and the effect on the expression of Cyclin D1 protein. METHODS A total of 120 patients with GC who underwent elective laparoscopic total gastrectomy from May 2015 to May 2018 were randomly divided into either a study group or a control group, with 60 cases in each group. The study group underwent "P"-shaped jejunal loop with esophagojejunal Roux-en-Y anastomosis for the reconstruction of the digestive tract, and the control group underwent esophagojejunal Roux-en-Y anastomosis. The operation time, intraoperative blood loss, postoperative patient nutritional status, complication rate, and Cyclin D1 protein expression were compared between the two groups. RESULTS There was no difference in intraoperative blood loss between the two groups(P > 0.05). The operation time and time to recovery of intestinal function were significantly shorter in the study group than in the control group(P < 0.05). Albumin, total protein, and hemoglobin levels in the study group were significantly higher than those of the control group(P < 0.05). The incidence of upper abdominal fullness and dumping syndrome in the study group was significantly lower than that of the control group(P < 0.05), while there was no significant difference in the incidence of diarrhea, reflux esophagitis, anastomotic stenosis, anastomotic bleeding, or pulmonary infection between the two groups(P > 0.05). The expression of Cyclin D1 protein was detected on the 7 th day after operation, and all patients had negative results. There was no significant difference between the two groups(P > 0.05). CONCLUSION Laparoscopic gastrointestinal reconstruction after total GC resection is beneficial to the recovery of digestive function, improve the postoperative nutritional level of patients, and dose not increase the expression level of Cyclin D1 protein.
作者
张树朋
徐杰
潘建柱
陈宗南
邵建平
珊巴嘎
Shu-Peng Zhang;Jie Xu;Jian-Zhu Pan;Zong-Nan Chen;Jian-Ping Shao;Ba-Zhen Shan(Department of General Surgery, The Fifth Central Hospital of Tianjin, Tianjin 300450, China)
出处
《世界华人消化杂志》
CAS
2019年第9期551-556,共6页
World Chinese Journal of Digestology
关键词
腹腔镜
消化道重建
胃癌
CYCLIND1蛋白
Laparoscopy
Digestive tract reconstruction
Gastric cancer
Cyclin D1 protein
作者简介
张树朋,主治医师,研究方向为胃肠肿瘤;通讯作者:邵建平,副主任医师, 300450,天津市新海新区塘沽浙江路41号,天津市第五中心医院普外科. jibanzu5195771@163.com.
