腹腔镜与开腹手术治疗胃肠道间质瘤的疗效及对外周血凝血功能影响的对比研究  

Comparative analysis of clinical effect and blood coagulation function between laparoscopic assisted and open distal gastrectomy of gastrointestinal stromal tumor

作　　者：徐继[1] 吴浩[1] 叶再元[1] 芮韬 何琦文[1] 邵钦树[1] 赵忠扩[1] 胡俊峰[1] 

机构地区：[1]浙江省人民医院胃肠外科,杭州310014

出　　处：《中国医师杂志》2015年第5期660-663,共4页Journal of Chinese Physician

摘　　要：目的 探讨腹腔镜与开腹手术治疗胃肠道间质瘤的临床疗效及对外周血凝血功能影响的对比.方法 回顾性分析2007年1月至2013年6月在本科行腹腔镜胃肠道间质瘤切除术患者41例（L组）,并比较同期开腹手术患者33例（O组）.对两组患者的手术时间、出血量、术后排气时间、住院时间、胃管放置时间、引流管放置时间、术后恢复饮食时间、并发症情况等进行比较分析,并检测患者术前和术后24 h凝血酶原国际标准化值（INR）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、D-二聚体以及纤维蛋白原（FIB）水平.结果 腹腔镜组与开腹组比较出血量[（105.39±19.91）ml vs（133.67±12.38） ml]、住院时间[（7.44±0.92）d vs （10.21±1.34）d]、胃管放置时间[（1.93 ±0.65）d vs （3.73 ±0.84）d]、引流管放置时间[（3.68±0.61）dvs （5.70±0.81）d]、术后恢复饮食时间[（7.12±1.05）d vs （8.98±0.81）d]差异均有统计学意义（P＜0.05）,腹腔镜组均优于开腹组.与手术前相比,开腹手术组与腔镜手术组患者术后PT均显著缩短（P＜0.05）,D-二聚体及FIB含量显著增高,且以腔镜手术组患者更为明显（P＜0.05）.结论 腹腔镜手术治疗GIST相对于传统的开放手术具有出血少,术后恢复快,拔管时间早等优势,但其可导致患者处于高凝状态,可能发生血栓性并发症,应予以重视.随着腹腔镜技术的不断成熟,可以适当选择腹腔镜手术方式治疗胃肠道间质瘤.Objective To investigate the clinical effect and blood coagulation functions between laparoscopic assistance and open distal gastrectomy in gastrointestinal stromal tumors.Methods A total of 74 patients （41 cases underwent laparoscopic assistance distal gastrectomy were named L group,33 cases received open distal gastrectomy were named O group） from January 2007 to June 2013 was analyzed retrospectively.The surgery time,mean blood loss,first flatus time,total hospital stay,pull out the nasogastric tube of time,complications after surgery,prothrombin international normalized value （INR）,prothrombin time （PT）,activated partial thromboplastin time （APTT）,D-dimer and fibrinogen （FIB） levels of two groups of patients were intraoperatively and postoperatively detected and analyzed.Results The conditions of L group were significantly better than O group in mean blood loss [（105.39 ± 19.91）ml vs （133.67 ±12.38）ml],total hospital stay [（7.44 ± 0.92）d vs （10.21 ± 1.34）d],pull out the nasogastric tube of time [（1.93 ±0.65）d vs （3.73 ±0.84）d],abdominal cavity drainage tube of time [（3.68 ±0.61）d vs （5.70 ± 0.81） d] （P 〈 0.05）.Compared to preoperation,both groups＆#39; postoperative prothrombin time （PT） was significantly shorten,D-dimer and fibrinogen （FIB） were significantly increased （P 〈 0.05）,which was more significant in L group （P 〈0.05）.Conclusions Laparoscopic-assisted distal gastrectomy is a safe and feasible procedure with rapid postoperative recover,pull out the tube of time.However,it might lead to a hypercoagulable state and thrombotic diseases,which should be paid attention.With the maturation of laparoscopic technology,we can appropriately choose laparoscopic surgery in the treatment of gastrointestinal stromal tumor.

关 键 词：腹腔镜检查 剖腹术 胃肠道间质肿瘤/外科学 血液凝固 

分 类 号：R735[医药卫生—肿瘤]