腹腔镜辅助远端胃癌D2根治术对肿瘤相关因子水平的影响分析

Effect of laparoscopic-assisted D2 radical resection for distal gastric cancer on the level of tumor related factors

摘要:

目的 探究腹腔镜辅助远端胃癌D2根治术治疗进展期胃癌对血清胃蛋白酶原（pepsinogen，PG）、胃泌素-17（gastrin-17，G-17）、低氧诱导因子-1α（hypoxia-inducible factor-1α，HIF-1α）及结肠癌转移相关基因1（metastasis-associated in colon cancer-1，MACC1）水平的影响。方法 选取2017年10月至2021年11月在中部战区总医院进行远端胃癌D2根治术治疗的患者110例进行临床及随访研究，根据治疗方法的不同分为腹腔镜组及开腹组，每组55例。比较2组患者围手术期情况，血清PG、G-17、HIF-1α及MACC1水平，以及生存情况差异。结果 腹腔镜组切口长度、术中出血量、排气时间、进食时间、首次下床时间、住院时间均明显低于开腹组，差异有统计学意义（P<0.05）。术后7 d，腹腔镜组患者血清PGⅠ水平明显高于开腹组（P<0.05），G-17、HIF-1α及MACC1水平低于开腹组（P<0.05）。术后早期，腹腔镜组患者的并发症总发生率低于开腹组（5.45% vs. 20.00%）（P<0.05）。腹腔镜组术后1、2、3年的生存率分别为90.91%、80.00%、78.18%，开腹组术后1、2、3年的生存率分别为87.27%、74.55%、70.91%，死亡率均无统计学意义（P>0.05）。log-rank检验腹腔镜组及开腹组治疗的患者生存状态比较差异无统计学意义（P>0.05）。结论 腹腔镜辅助远端胃癌D2根治术治疗进展期胃癌的效果及安全性较好，可促进患者术后早期康复，改善患者PG、G-17、HIF-1α及MACC1水平。

Abstract:

Objective To explore the effect of laparoscopic-assisted D2 radical resection for advanced distal gastric cancer on serum pepsinogen（PG），gastrin-17（G-17），hypoxia-inducible factor-1α（HIF-1α），and metastasis-associated in colon cancer-1（MACC1） levels.Methods A total of 110 patients who underwent D2 radical resection for distal gastric cancer in General Hospital of Central Theater Command from October 2017 to November 2021 were selected for clinical and follow-up study. According to the different treatment methods，they were divided into the laparoscopic group and the laparotomy group，with 55 cases in each. Perioperative conditions，serum PG，G-17，HIF-1α and MACC1 levels，and differences in survival between the two groups of patients were compared.Results The length of incision，intraoperative blood loss，exhaust time，eating time，time to first get out of bed， and hospital stay in the laparoscopic group were significantly lower than those in the laparotomy group，and the differences were statistically significant（P<0.05）. On the 7th day after operation， the serum PGⅠ level in the laparoscopy group was significantly higher than that in the laparotomy group（P<0.05），and the levels of G-17，HIF-1α and MACC1 were lower than those in the laparotomy group（P<0.05）. In the early postoperative period，the overall incidence of complications in the laparoscopic group was lower than that in the laparotomy group（5.45% vs. 20.00%）（P<0.05）. The 1-，2-，and 3-year survival rates were 90.91%，80.00%，and 78.18% in the laparoscopic group，and 87.27%，74.55%，and 70.91% in the laparotomy group，and the mortality rate was not statistically significant（P>0.05）. There was no significant difference in survival status between the laparoscopic group and the laparotomy group by log-rank test（P>0.05）.Conclusion Laparoscopy-assisted D2 radical resection for distal gastric cancer has good effect and safety in the treatment of advanced gastric cancer. It can promote early postoperative recovery of patients，and improve patients' PG，G-17，HIF-1α and MACC1 levels.