比较进展期胃癌患者腹腔镜与开腹胃癌D2根治术前后氧化应激、T细胞及炎症因子变化。

回顾性分析2016年3月至2017年12月92例进展期胃癌患者资料，根据不同术式分为两组，51例开腹胃癌D2根治术患者为ORG组，41例腹腔镜下行胃癌D2根治术患者为LRG组，应用SPSS18.0统计软件进行数据分析，氧化应激水平(SOD、GSH－PX、MDA、AOPP)、T细胞和炎症因子计量资料以(±s)表示，采用独立t检验；术后并发症采用χ²检验，P<0.05为差异有统计学意义。

两组患者术后SOD、GSH－PX水平较术前明显降低，MDA、AOPP水平较术前明显升高(P<0.05)。术后LRG组SOD、GSH－PX水平明显高于ORG组，MDA、AOPP水平明显低于ORG组(P<0.05)。两组术后CD4^＋CD25^＋、IL－6、IL－8、TNF－α水平较术前均有明显提高(P<0.05)，但LRG组术后CD4^＋CD25^＋水平明显高于ORG组；IL－6、IL－8、TNF－α水平明显低于ORG组(P<0.05)。LRG组平均手术时间、平均出血量、淋巴结清扫数均优于ORG组(P<0.05)。ORG组并发症发生率为3.9%，LRG组为4.9%，差异无统计学意义(P>0.05)。

腹腔镜D2根治术与开腹D2根治术治疗进展期胃癌比较，前者对机体损伤小，出血少，氧化应激、炎性反应小，免疫抑制轻，更有利于患者术后恢复。

To compare the changes of oxidative stress, T cells and inflammatory factors of patients with advanced gastric cancer who underwent D2 radical gastrectomy.

From March 2016 to December 2017, clinical data of 92 patients with advanced gastric cancer were analyzed retrospectively. Fifty-one patients underwent D2 open radical gastrectomy were divided into the ORG group and 41 patients received D2 laparoscopic radical gastrectomy were divided into the LRG group. SPSS 18.0 software was used to analyze the data. Measurement data such as MDA, AOPP, T cells and the inflammatory cytokines were expressed as mean±standard deviation and were examined by independent t test. Count data such as postoperative complications were described by (n, %) and were examined by chi square test. A P value of <0.05 was considered as statistically significant.

The levels of SOD, GSH-PX decreased and MDA and AOPP increased significantly in both two groups after operation (P<0.05). The levels of SOD and GSH-PX in LRG group were significantly higher than those in the ORG group, while the levels of MDA and AOPP in the LRG group were significantly lower than those in the ORG group respectively (P<0.05). The levels of CD4⁺ CD25⁺ Tc, IL-6, IL-8 and TNF-alpha increased significantly in both two groups (P<0.05), but the levels of CD4⁺ CD25⁺ Tc in the LRG group were significantly higher than that in the ORG group, and the levels of IL-6, IL-8 and TNF-alpha in the LRG group were significantly lower than those in the ORG group respectively (P<0.05). The average operation time of the LRG group was shorter than that of the ORG group, the average amount of bleeding was less than that of the ORG group, and the number of lymph node dissection was more than that of the ORG group, with significant difference (P<0.05). The incidence of complications was 3.9% in the ORG group and 4.9% in LRG group with no significant difference (P>0.05).

Compared with open D2 radical operation, laparoscopic D2 radical operation has less damage, less bleeding, less oxidative stress, less inflammatory reaction and less immunosuppression, which is more conducive to the recovery of patients with advanced gastric cancer.