穴位电刺激联合皮肤交感反应评估腹腔镜胃癌根治术自主神经保留的临床研究  

Clinical study on transcutaneous electrical acupoint stimulation combined with skin sympathetic response to evaluate autonomic nerve preservation after laparoscopic radical gastrectomy

作　　者：丁清竹 高进 王会娜 程之逸 黄传江 刘贵远 赵小军[1] 车星 尤小兰 Ding Qingzhu;GaoJin;Wang Huina;Cheng Zhiyi;Huang Chuanjiang;Liu Guiyuan;Zhao Xiaojun;Che Xing;You Xiaolan(Department of Gastrointestinal Surgery,Taizhou People's Hospital,Taizhou 225300,China)

机构地区：[1]南京医科大学附属泰州人民医院胃肠外科,泰州225300

出　　处：《中华胃肠外科杂志》2025年第2期178-184,共7页Chinese Journal of Gastrointestinal Surgery

基　　金：南京医科大学泰州临床医学院科研项目(TZKY20220206)。

摘　　要：目的探索穴位电刺激联合皮肤交感反应能否评估胃癌根治手术胃周自主神经保留的成功与否。方法采用回顾性队列研究方法。对2022年6月至2024年9月在南京医科大学附属泰州人民医院胃外科行腹腔镜胃癌根治术的221例患者的临床资料进行回顾性分析。其中109例患者行不保留胃周自主神经腹腔镜根治性全胃切除(全胃切除非保留神经组);112例行腹腔镜根治性远端胃切除, 术中有34例保留胃周自主神经(保留神经组), 78例不保留胃周自主神经(非保留神经组)。全胃切除非保留神经组术前1天和术后第1天电刺激足三里和天枢穴位, 记录经皮电刺激联合交感神经皮肤反应(SSR)上肢及下肢潜伏期及电压波幅, 并进行手术前后的比较。远端胃切除的两个组于术后第1天记录经皮电刺激联合SSR上肢及下肢潜伏期及电压波幅的组间差异;术后第1、2、3天连续电刺激足三里和天枢穴位15 min, 同时听诊并记录远端胃切除两组患者肠鸣音, 记录肠功能恢复时间, 并比较远端胃切除两组患者手术时间、术中出血、淋巴结清扫数目、术后3天炎性指标包括白介素6(IL-6)、C反应蛋白(CRP)和降钙素原(PCT)以及吻合口漏发生率, 术后3个月胃镜检查评估残胃食物残留和胆汁反流情况, 并评估患者预后营养指数(PNI)等的组间差异。结果全胃切除非保留神经组术后电刺激足三里联合上肢SSR记录的潜伏期为(2 359.71±410.55)ms, 电压波幅为(0.43±1.67)mV, 下肢则分别为(2 596.88±369.01)ms和(0.25±0.08)mV;术后电刺激天枢联合上肢SSR记录的潜伏期为(2 746.47±224.37)ms, 电压波幅为(0.31±0.14)mV, 下肢则分别为(2 891.90±193.61)ms和(0.19±0.72)mV;术后SSR潜伏期均较术前延长, 电压波幅均下降, 手术前后比较, 差异均有统计学意义(均P<0.01)。根治性远端胃切除保留神经组电刺激足三里联合上肢SSR记录的潜伏期为(1 668.04±261.91)ms, 电�Objective This study aimed to explore the utility of transcutaneous electrical acupoint stimulation(TEAS)combined with skin sympathetic response(SSR)in assessing the effectiveness of perigastric autonomic nerve preservation during radical gastrectomy.Methods A retrospective cohort analysis was conducted involving 221 patients who underwent laparoscopic radical gastrectomy at the Department of Gastric Surgery,Taizhou People's Hospital,affiliated with Nanjing Medical University,between June 2022 and September 2024.The cohort comprised 109 patients who underwent laparoscopic radical total gastrectomy without autonomic nerve preservation(total gastrectomy without nerve preservation group).Additionally,112 patients underwent laparoscopic radical distal gastrectomy,including 34 patients who received autonomic nerve preservation(nerve preservation group)and 78 patients who did not(without nerve preservation group).TEAS was administered at the Zusanli and Tianshu acupoints one day before and one day after surgery,during which SSR latency and voltage amplitudes in the upper and lower extremities were recorded and compared across groups.Differences in SSR latency and voltage amplitude between the nerve preservation and non-nerve preservation groups of the distal gastrectomy cohort were also analyzed.Further,TEAS was applied at the same acupoints for 15 minutes on the 1st,2nd,and 3rd postoperative days,and changes in intestinal sounds and intestinal functional recovery time were monitored.Surgical parameters,including operative duration,intraoperative blood loss,and harvested lymph node,were documented.Postoperative inflammatory indicators,including interleukin-6(IL-6),C-reactive protein(CRP),procalcitonin(PCT),and the incidence of anastomotic leakage,were evaluated.At three months postoperatively,gastroscopy was performed to assess residual gastric food and bile reflux.Additionally,the prognostic nutritional index(PNI)was evaluated across all patient groups.Results Following total gastrectomy,TEAS of Zusanli combined with

关 键 词：胃肿瘤 外科手术 自主神经 皮肤交感反应 经皮穴位电刺激 

分 类 号：R735.2[医药卫生—肿瘤]