CAJ | 학술논문

目的探讨达芬奇机器人手术系统、腹腔镜及开腹胃癌根治术腹腔冲洗液CEA和多巴脱羧酶(DDC)的变化.方法回顾性分析2013年1月至2014年3月第三军医大学西南医院收治的126例行胃癌根治术患者的临床资料,其中行达芬奇机器人手术系统胃癌根治术、腹腔镜胃癌根治术、开腹胃癌根治术者各42例,设为机器人手术组、腹腔镜手术组和开腹手术组.收集患者手术前后腹腔冲洗液,采用ELISA法检测CEA和DDC浓度.计量资料采用配对t检验及方差分析,多重比较采用LSD法,计数资料采用x2检验及非参数检验.结果机器人手术组、腹腔镜手术组和开腹手术组患者术前腹腔冲洗液中CEA浓度分别为(242±189) μg/L、(221±174) μg/L和(257±135) iμg/L,术后CEA浓度分别为(1 262 ±785) μg/L、(1 172 ±699) μg/L和(2 996±1 947) μg/L;3组患者术前腹腔冲洗液中DDC浓度分别为(8±5) μg/L、(7±4) μg/L和(8±6) μg/L,术后DDC浓度分别为(87±55) μg/L、(81 ±52) μg/L和(146±135) lμg/L.3组患者术前CEA与DDC浓度比较,差异无统计学意义(F =0.491,0.161,P＞0.05);3组患者术后CEA与DDC浓度比较,差异有统计学意义(F =27.214,6.865,P＜0.05).两两比较术后CEA与DDC浓度发现:开腹手术组较腹腔镜及机器人组明显升高(P＜0.05),而腹腔镜手术组与机器人手术组比较,差异无统计学意义(P＞0.05).分析同种手术方式手术前后腹腔冲洗液中CEA和DDC浓度:3组术后CEA和DDC浓度均较术前显著增高,差异有统计学意义(t=-11.053、-11.700、-9.780,-10.261、-9.955、-6.969,P＜0.05).结论达芬奇机器人手术系统胃癌根治术与腹腔镜胃癌根治术比较,术后腹腔冲洗液中CEA和DDC浓度差异无统计学意义,但均明显低于开腹胃癌根治术,对于防止CEA和DDC介导的胃癌腹腔转移可能有一定作用.
목적 탐토체분기궤기인수술계통、복강경급개복위암근치술복강충세액CEA화다파탈최매(DDC)적변화.방법 회고성분석2013년1월지2014년3월제삼군의대학서남의원수치적126례행위암근치술환자적림상자료,기중행체분기궤기인수술계통위암근치술、복강경위암근치술、개복위암근치술자각42례,설위궤기인수술조、복강경수술조화개복수술조.수집환자수술전후복강충세액,채용ELISA법검측CEA화DDC농도.계량자료채용배대t검험급방차분석,다중비교채용LSD법,계수자료채용x2검험급비삼수검험.결과 궤기인수술조、복강경수술조화개복수술조환자술전복강충세액중CEA농도분별위(242±189) μg/L、(221±174) μg/L화(257±135) iμg/L,술후CEA농도분별위(1 262 ±785) μg/L、(1 172 ±699) μg/L화(2 996±1 947) μg/L;3조환자술전복강충세액중DDC농도분별위(8±5) μg/L、(7±4) μg/L화(8±6) μg/L,술후DDC농도분별위(87±55) μg/L、(81 ±52) μg/L화(146±135) lμg/L.3조환자술전CEA여DDC농도비교,차이무통계학의의(F =0.491,0.161,P＞0.05);3조환자술후CEA여DDC농도비교,차이유통계학의의(F =27.214,6.865,P＜0.05).량량비교술후CEA여DDC농도발현:개복수술조교복강경급궤기인조명현승고(P＜0.05),이복강경수술조여궤기인수술조비교,차이무통계학의의(P＞0.05).분석동충수술방식수술전후복강충세액중CEA화DDC농도:3조술후CEA화DDC농도균교술전현저증고,차이유통계학의의(t=-11.053、-11.700、-9.780,-10.261、-9.955、-6.969,P＜0.05).결론 체분기궤기인수술계통위암근치술여복강경위암근치술비교,술후복강충세액중CEA화DDC농도차이무통계학의의,단균명현저우개복위암근치술,대우방지CEA화DDC개도적위암복강전이가능유일정작용.
Objective To explore the change of carcinomacmbryonic-antigen (CEA) and dopa decarboxylase (DDC) in the peritoneal irrigation fluid from patients undergoing Da Vinic robotic,laparoscopic and open radical gastrectomy for gastric cancer.Methods The clinical data of 126 patients undergoing radical gastrectomy for gastric cancer at the Southwest Hospital from January 2013 to March 2014 were retrospectively analyzed.There were 42 patients in the Da Vinic robotic radical gastrectomy group (RRG group),42 in the laparoscopic radical gastrectomy group (LRG group) and 42 in the open radical gastrectomy group (ORG group).The preoperative and postoperative peritoneal irrigation fluids were collected,respectively.Concentrations of CEA and DDC in the peritoneal irrigation fluids were detected by the enzyme-linked immunosorbent assay (ELISA).The quantitative data were analyzed using the t test and the chi-squared test,the multiple comparison were analyzed using the least significance difference (LSD) and the count data were analyzed using the chi-square test and nonparametric test.Results The preoperative and postoperative concentrations of CEA in the RRG group,LRG group and ORG group were (242 ± 189)xg/L,(221 ± 174)μg/L,(257 ± 135) μg/L and (1 262 ± 785) μg/L,(1 172 ± 699) iμg/L,(2 996 ± 1 947) μg/L,respectively.The preoperative and postoperative concentration of DDC in the RRG group,LRG group and ORG group were (8 ±5)μg/L,(7 ±4)μg/L,(8 ±6)μg/L and (87 ±55) μg/L,(81 ±52) pg/L,(146 ± 135)μg/L,respectively.No significant differences were observed for the preoperative concentrations of CEA and DDC in the 3 groups (F =0.491,0.161,P ＞ 0.05),and the postoperative concentration of CEA and DDC in the 3 groups were significantly different (F =27.214,6.865,P ＜ 0.05).The postoperative concentration of CEA and DDC in the ORG group were significantly higher than those in the RRG group and LRG group (P ＜ 0.05),while no significant differences in the postoperative concentration of CEA and DDC were observed between the LRG group and RRG group (P ＞ 0.05).The preoperative and postoperative concentrations of CEA and DDC were significantly increased in all the 3 groups,with a significant difference when compared with the preoperative concentrations of CEA and DDC (t =-11.053,-11.700,-9.780,-10.261,-9.955,-6.969,P ＜0.05).Conclusion The postoperative concentration of CEA and DDC in the peritoneal irrigation fluid after Da Vinic robotic radical gastrectomy is significant decreased when compared with the open radical gastrectomy,while no significant difference is observed between the Da Vinci robotic radical gastrectomy and the laparoscopic radical gastrectomy,which is helpful for preventing CEA-and DDC-mediated abdominal metastasis of gastric cancer.