CAJ | 학술논문

目的：对比腹腔镜与开腹远端胃癌根治术的疗效及对凝血功能的影响。方法选取行腹腔镜远端胃癌根治术的患者56例（观察组）及同期开腹远端胃癌根治术患者56例（对照组）。对两组患者的术中及术后情况、淋巴结清扫数目、并发症等进行比较分析，并检测比较两组患者术前、术后24h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（D- D）以及纤维蛋白原（FIB）水平。结果观察组手术时间长于开腹组，而术中出血量、切口长度、术后首次肛门排气时间、术后镇痛药使用次数、住院时间均少于开腹组，差异均有统计学意义（均P＜0.01）。与手术前比较，仅观察组患者PT显著延长，差异有统计学意义（P＜0.05）；与对照组比较，观察组PT显著延长，差异有统计学意义（P＜0.05）。与术前相比，两组患者术后FIB及D- D体均明显增高，差异均有统计学意义（均P＜0.05）；观察组患者术后FIB及D- D较对照组明显增高，差异有统计学意义（P＜0.05）。观察组术后并发症发生率明显低于对照组（10.7%、14.3%），差异有统计学意义（P＜0.05）。结论腹腔镜远端胃癌根治术具有安全、术后恢复快等优点，且在淋巴结清扫方面能达到与开腹手术相同的效果，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。
목적：대비복강경여개복원단위암근치술적료효급대응혈공능적영향。방법선취행복강경원단위암근치술적환자56례（관찰조）급동기개복원단위암근치술환자56례（대조조）。대량조환자적술중급술후정황、림파결청소수목、병발증등진행비교분석，병검측비교량조환자술전、술후24h응혈매원국제표준화치（INR）、응혈매원시간（PT）、활화부분응혈활매시간（APTT）、D-이취체（D- D）이급섬유단백원（FIB）수평。결과관찰조수술시간장우개복조，이술중출혈량、절구장도、술후수차항문배기시간、술후진통약사용차수、주원시간균소우개복조，차이균유통계학의의（균P＜0.01）。여수술전비교，부관찰조환자PT현저연장，차이유통계학의의（P＜0.05）；여대조조비교，관찰조PT현저연장，차이유통계학의의（P＜0.05）。여술전상비，량조환자술후FIB급D- D체균명현증고，차이균유통계학의의（균P＜0.05）；관찰조환자술후FIB급D- D교대조조명현증고，차이유통계학의의（P＜0.05）。관찰조술후병발증발생솔명현저우대조조（10.7%、14.3%），차이유통계학의의（P＜0.05）。결론복강경원단위암근치술구유안전、술후회복쾌등우점，차재림파결청소방면능체도여개복수술상동적효과，단기가도치환자처우고응상태，가능발생혈전성병발증，응여이중시。
Objective To compare the clinical effects between laparoscopic assistance and open distal gastrectomy for patients with gastric cancer. Methods Fifty six patients with gastric cancer underwent laparoscopic assistance distal gastrecto-my (group L) and 56 cases received open distal gastrectomy (group O) were included in the study.The intraoperative and post-operative information, the number of dissected lymph nodes, postoperative complications were compared between two groups. The prothrombin international normalized value(INR), prothrombin time(PT), activated partial thromboplastin time (APTT), D- dimer and fibrinogen (FIB) levels were measured before and after operation in both groups. Results The operative time in group L was significantly longer than that in group O.However,the mean blood loss,the frequency of analgesics use after operation were less and first flatus time, total hospital stay were shorter in group L than those in group O (al P<0.01).The postoperative prothrombin time(PT) was significantly increased than that before operation in group L(P<0.05), and PT in group L was also significantly high-er than that in group O (P<0.05). Compared with preoperative levels, D- dimer and fibrinogen (FIB) in both groups were signifi-cantly increased (P<0.05);while the postoperative D- dimer and fibrinogen (FIB) levels in group L were significantly higher than those in group O (P<0.05). The postoperative complications in group L were significantly lower than those in group O (10.7%vs 14.3%, P<0.05). Conclusion Laparoscopic- assisted distal gastrectomy is a safe and feasible procedure, but it may lead to hy-percoagulative state and thrombotic diseases.