腹腔镜胃癌D2根治术中不同CO2气腹压力对早期和局部进展期远端胃癌患者肠黏膜损伤及肠功能恢复的影响  

Effects of different CO2 pneumoperitoneum pressure on intestinal mucosal injury and intestinal function recovery in patients with early and locally advanced gastric cancer during D2 radical gastrectomy for gastric cancer

作　　者：李辉 惠广学 Li Hui;Hui Guangxue(Abdominal Surgery,Linyi Cancer Hospital,Linyi 276001,China)

机构地区：[1]临沂市肿瘤医院腹外一科,276001

出　　处：《国际医药卫生导报》2018年第23期3651-3654,共4页International Medicine and Health Guidance News

摘　　要：目的 分析不同CO2气腹压力在腹腔镜胃癌D2根治术中对早期与局部进展期远端胃癌患者肠黏膜损伤及肠功能恢复的影响。方法 将本院2016年2月至2018年2月收治的200例均行手术治疗的早期与局部进展期远端胃癌患者作为研究对象,其中开腹胃癌D2根治术为A组(79例),腹腔镜胃癌D2根治术为B组(121例)。B组患者中,根据CO2气腹压力的不同,将其分为低度组[CO2气腹压力为8~10 mmHg(1 mmHg=0.133 kPa)]、中度组(CO2气腹压力为11~13 mmHg)、重度组(CO2气腹压力为14~16 mmHg)。比较各组患者术后肠黏膜损伤程度、并发症发生情况及术后住院时间和肠功能的恢复情况。结果 A组患者术后肠黏膜损伤程度较轻;B组患者中,重度组患者术后肠黏膜损伤程度较轻度组、中度组严重。B组(2.48%)并发症发生率较A组(25.32%)显著降低(P<0.05)。重度组术后住院时间[(8.24±1.42)d]与A组[(8.42±2.43)d]比较差异无统计学意义(P>0.05);但与轻度组[(4.98±0.47)d]、中度组[(7.05±1.14)d]比较,均明显延长(P<0.05)。重度组患者术后排气时间[(5.47±0.99)d]、肠鸣音出现时间[(4.58±1.24)d]、进食时间[(6.14±1.27)d]较其他组明显延长(P<0.05)。结论 腹腔镜胃癌D2根治术对早期与局部进展期远端胃癌患者的治疗具有微创、安全等显著优势,但若CO2气腹压力较高,则容易引起术后肠黏膜损伤,对肠功能的恢复极为不利,因此根治术中在确保手术视野清晰的条件下,应尽可能减少CO2气腹压力。Objective To analyze the effect of different CO2 pneumoperitoneum pressure on intestinal mucosal injury and intestinal function recovery in patients with early and locally advanced gastric cancer undergoing laparoscopic D2 radical gastrectomy for gastric cancer.Methods 200 patients with early and locally advanced gastric cancer who were treated surgically in our hospital from February 2016 to February 2018 were selected as the research subjects.Among them,79 cases underwent open D2 radical gastrectomy(group A),and 121 cases underwent laparoscopic D2 radical gastrectomy for gastric cancer(group B).In group B,according to the difference of CO2 pneumoperitoneum pressure,121 cases were divided into low-degree group[CO2 pneumoperitoneum pressure for 8-10 mmHg(1 mmHg=0.133 kPa)],moderate-degree group(CO2 pneumoperitoneum pressure for 11-13 mmHg),and high-degree group(CO2 pneumoperitoneum pressure for 14-16 mmHg).The degree of intestinal mucosal injury,the occurrence of complications,the time of postoperative hospitalization,and the recovery of intestinal function were compared among groups.Results The degree of intestinal mucosal injury in group A was lighter;while in group B,the degree of intestinal mucosal injury in severe group was more severe than that in mild group and moderate group.The incidence of complications in group B(2.48%)was significantly lower than that in group A(25.32%)(P<0.05).There was no statistically significant difference in the time of hospitalization between the severe group[(8.24±1.42)d]and the group A[(8.42±2.43)d](P>0.05),but it was significantly longer than that in the mild group[(4.98±0.47)d]and the moderate group[(7.05±1.14)d](P<0.05).The postoperative exhaust time[(5.47±0.99)d],bowel sounds appear time[(4.58±1.24)d]and eating time[(6.14±1.27)d]in severe group were longer than those in the other groups(P<0.05).Conclusions Laparoscopic D2 radical gastrectomy for gastric cancer has the advantages of less invasive and safe for the treatment of early and locally advanced distal gastric

关 键 词：腹腔镜 根治术 胃癌 气腹压力 肠黏膜 肠功能 

分 类 号：R735.2[医药卫生—肿瘤]