腹腔镜与开腹胃癌切除手术前后凝血和纤溶分子标志物变化的对比研究  

Comparative study on laparoscopic and open resection of gastric cancer changes of molecular markers of coagulation and fibrinolysis before and after operation solution

作　　者：罗利民 胡明[2] 

机构地区：[1]广州市番禺区钟村医院,广东广州511495 [2]广州医学院第一附属医院,广东广州511800

出　　处：《中国现代医生》2014年第13期127-129,共3页China Modern Doctor

基　　金：广东省医学科学技术研究基金资助(wstjj 2011110636210119661125031X)

摘　　要：目的比较腹腔镜与开腹胃癌切除手术前后凝血及纤溶分子标志物的变化,评价腹腔镜胃癌手术的安全性。方法本组71例胃癌患者,分为腹腔镜辅助下全胃切除术组(A组)35例和开腹全胃切除术组(B组)36例,对两组病例手术前后的血浆纤溶酶原激活物(t-PA)、血浆纤溶酶原激活物抑制物(PAI-1)和凝血酶-抗凝血酶复合物(TAT)三项凝血及纤溶分子标志物进行分析比较。结果 A组与B组组间比较,手术前后各时间点反映凝血和纤溶系统活性的特异性分子标志物(t-PA、PAI-1和TAT)的浓度差异无统计学意义(P>0.05)。两组的t-PA、PAI-1和TAT的变化趋势相似:术后1h、24h较术前1d均明显升高(P<0.01),术后72h恢复到术前1h水平。结论行腹腔镜与开腹胃癌切除术患者术后血液均处于高凝状态,但与开腹手术相比,腹腔镜手术并未显著加重对血凝状态的影响,可有效降低术后发生血栓的风险,腹腔镜胃癌全胃切除术是一种安全、微创的手术方法。Objective To compare laparoscopic operation and open resection for the changes of molecular markers of coagulation and fibrinolytic before and after operation, and evaluate the safety of laparoseopie operation of gastric can- cer. Methods A total of 71 cases of patients with gastric cancer, laparoscopie assisted total gastrectomy were divided into group （A group） 35 cases and open total gastrectomy group （B group） 36 cases, two cases of plasma before and after the operation of the plasminogen activator （t-PA）, plasminogen activator inhibitor （PAl-l） and thrombin antithrombin complex compounds （TAT） of three molecular markers of coagulation and fibrinolytic system were compared and ana- lyzed. Results In A group compared with B group at all time points before and after operation, reflecting the specific molecular markers of coagulation and fibrinolytic system activity（t-PA, PAI-1 and TAT） was no significant difference （P 〉0.05） concentration. Change trend of two groups of t-PA, PAI-1 and TAT were similar： postoperative 1H, 24h com- pared with the preoperative 1D were significantly increased （P 〈0.01）, 72h after operation recovered to the preoperative level of lh. Conclusion Laparoscopic and open resection for gastric cancer patients after blood is in hypercoagulable state, but compared with open operation, laparoscopic operation did not significantly increase effect on blood coagula- tion, thrombosis risk can be effectively reduced after surgery, laparoscopic total gastrectomy for gastric cancer is a safe, minimally invasive operation method.

关 键 词：腹腔镜 胃癌 全胃根治切除术 凝血 纤溶 

分 类 号：R735.2[医药卫生—肿瘤]