Wu Xudong, Wang Xingguang, Wang Yong, Cui Weichun, Liu Pengfei
Department of Gastroenterological Surgery, Dongying People's Hospital, Dongying 257091, P.R. China.
J BUON. 2020 Jan-Feb;25(1):324-331.
This study aimed to compare between the clinical efficacy of laparotomy and laparoscopic radical resection of gastric cancer and their effects on C-reactive protein (CRP), carcinoembryonic antigen (CEA) and insulin resistance.
210 patients with gastric cancer admitted to Dongying People's Hospital from September 2013 to July 2015 were included in this study. The patients were divided according to surgery type into the laparotomy group (n = 104) and the laparoscopy group (n = 106). The operative time, intraoperative bleeding, lymph node dissection, postoperative exhaust time and postoperative complications were recorded. Peripheral blood CRP and CEA levels were measured by enzyme-linked immunosorbent assay (ELISA). Fasting blood glucose (FBG), AND fasting insulin (FINS) levels were measured before operation and 1, 3 and 7 days after operation. All patients were followed up by telephone and letters for 5 years. The patients in the two groups were investigated by a quality of life questionnaire.
The intraoperative bleeding and postoperative exhaust time in THE laparoscopy group were significantly lower than those in the traditional laparotomy group, while the operative time and the number of lymph node dissections were higher. The CRP and CEA in the laparoscopy group were significantly lower than in the laparotomy group on the 1ST, 2ND and 3RD day after operation (p<0.05). The FBG, FINS and HOMA-IR in the laparoscopy group were significantly lower than those in the laparotomy group on the 1ST and 3RD day after operation (p<0.05). The scores of quality of life in the laparoscopy group were lower than those in the laparotomy group (p<0.05).
In conclusion, laparoscopic radical resection of gastric cancer can reduce the levels of CRP, CEA and insulin resistance, while the degree of inflammation and insulin resistance after laparoscopy is lower than that after laparotomy, which is beneficial to postoperative recovery.
本研究旨在比较开腹与腹腔镜胃癌根治术的临床疗效及其对C反应蛋白（CRP）、癌胚抗原（CEA）和胰岛素抵抗的影响。
纳入2013年9月至2015年7月在东营市人民医院收治的210例胃癌患者。根据手术方式将患者分为开腹组（n = 104）和腹腔镜组（n = 106）。记录手术时间、术中出血量、淋巴结清扫情况、术后排气时间及术后并发症。采用酶联免疫吸附测定（ELISA）法检测外周血CRP和CEA水平。于术前及术后1、3、7天测量空腹血糖（FBG）和空腹胰岛素（FINS）水平。所有患者通过电话和信件随访5年。采用生活质量问卷对两组患者进行调查。
腹腔镜组术中出血量和术后排气时间显著低于传统开腹组，而手术时间和淋巴结清扫数量较多。术后第1、2、3天腹腔镜组的CRP和CEA显著低于开腹组（p<0.05）。术后第1天和第3天腹腔镜组的FBG、FINS和HOMA-IR显著低于开腹组（p<0.05）。腹腔镜组生活质量评分低于开腹组（p<0.05）。
综上所述，腹腔镜胃癌根治术可降低CRP、CEA水平及胰岛素抵抗，且腹腔镜术后炎症程度和胰岛素抵抗低于开腹手术，有利于术后恢复。
