观察腹腔镜与开腹手术在进展期远端胃癌治疗中患者的应激反应情况及临床疗效。

2015年1月至2017年1月期间，前瞻性研究收治的进展期胃癌患者94例，将患者随机分为腹腔镜组和开腹手术组，每组各47例。腹腔镜组给予腹腔镜下远端胃癌根治术，开腹手术组给予开腹远端胃癌根治术，术后随访1年，观察两组患者手术情况、术后康复情况和临床结局。采用SPSS22.0进行统计分析，两组术中术后指标和AngII水平等采用(±s)表示，采用独立样本t检验；术后并发症行χ²检验；以P<0.05差异有统计学意义。

腹腔镜组患者术中出血量明显少于开腹手术组，差异具有显著统计学意义(P＝0.000)；两组患者术前AngII和CRP均无统计学差异(P>0.05)，术后24 h时，腹腔镜组患者应激反应指标AngII、CRP水平显著低于开腹手术组(P＝0.000)。与开腹手术组比较，腹腔镜组患者术后肛门排气时间显著缩短(P＝0.000、住院时间显著缩短(P＝0.000)、术后引流时间显著缩短(P＝0.017)、引流量显著减少(P＝0.009)。腹腔镜组并发症总发生率明显低于开腹手术组，差异具有统计学意义(P＝0.014)。两组患者手术时间、淋巴结清扫数目、死亡率和复发率等比较差异均无统计学意义(P>0.05)。

腹腔镜下远端胃癌根治术是安全有效的，可以显著降低患者术后应激反应，减少术后并发症发生率，加速患者术后康复。

To compare safety and efficacy of the laparoscopy and laparotomy on the treatment of advanced distal gastric carcinoma.

94 advanced gastric carcinoma patients from January 2015 to January 2017 in our hospital were retrospectively collected and were divided into one observation group and one control group, 47 patients each group. The patients in the observation group received laparoscopy-assisted radical gastrectomy for distal gastric carcinoma while the ones in the control group received laparotomy-assisted radical gastrectomy for distal gastric carcinoma, and all patients were followed-up 1 year. Operation condition, postoperative rehabilitation and clinical outcomes of the patients in both groups were observed. SPSS22.0 was used for statistical analysis, The intraoperative and postoperative indexes and AngII level in the two groups were expressed by(±s), T test of independent samples was used; Postoperative complications were examined by ray test, The difference was statistically significant (P<0.05).

The intraoperative blood loss in the observation group was significantly less than that in the control group, and the difference was statistically significant (P=0.000); There was no significant difference in preoperative AngII and CRP between the two groups (P>0.05), After 24 h, the indexes of stress reaction AngII and CRP in the observation group were significantly lower than those in the control group (P=0.000). Compared with the control group, the anal exhaust time of the observation group was significantly shortened (P=0.000), and the length of hospital stay was significantly shortened (P=0.000), The postoperative drainage time was significantly shortened (P=0.017), and the flow rate was significantly shortened (P=0.009). The total incidence of complications in the observation group was significantly lower than that in the control group, the difference was statistically significant (P=0.014). The operation time, the number of lymph node dissection, mortality and recurrence rate were not significantly different between the two groups (P>0.05).

Laparoscopic distal gastrectomy is safe and effective, which can significantly reduce postoperative stress response, reduce postoperative complications, and accelerate postoperative rehabilitation.