腹腔镜远端胃癌D2根治术对老年进展期胃癌病人CEA、DDC及血清HIF1α、MACC1的影响

doi:10.3969/j.issn.10056483.2018.10.007

摘要/Abstract

摘要： 目的探讨腹腔镜辅助远端胃癌D2根治术治疗老年进展期胃癌的临床预后，并观察其对腹腔冲洗液癌胚抗原（CEA）、多巴胺脱羧酶（DDC）及血清低氧诱导因子1α（HIF1α）、结肠癌转移相关基因 1（MACC1）表达的影响。方法将120例行远端胃癌根治术的老年病人分为腹腔组和开腹组,每组各60例，分别行腹腔镜和开腹远端胃癌D2根治术。比较两组病人围手术期情况、生存情况及复发转移情况，术前及术后测定血清HIF1α、MACC1及腹腔冲洗液CEA、DDC水平。结果腹腔镜组手术时间、淋巴清扫数、近切端与肿瘤距离、远切端与肿瘤距离、术后并发症率依次为（163.05±15.41）分钟、（26.89±4.55）枚、（7.04±1.13）cm、（6.13±1.04）cm、3.33%，开腹组为（158.23±13.44）分钟、（28.41±5.23）枚、（7.22±1.28）cm、（6.02±1.13）cm和11.67%比较，两组比较差异无统计学意义（P>0.05）；腹腔镜组的切口长度、术中出血量、术后肛门排气时间、进食时间、下床活动时间及住院时间分别为（5.23±1.26）cm、（155.01±30.21）ml、（4.12±0.65）天、（4.15±0.71）天、（2.91±0.44）天、（12.69±2.45）天，开腹组分别为（16.32±2.53）cm、（351.91±42.16）ml、（5.13±1.02）天、（5.22±1.14）天、（4.82±1.13）天、（18.12±4.43）天比较，差异有统计学意义（P<0.05）。腹腔镜组术后腹腔冲洗液中CEA、DDC含量和血清HIF1α、MACC1依次为（1423.49±331.56）ng/ml 、（115.03±30.21）ng/ml、（45.02±10.03）pg/ml、（76.69±12.45）pg/ml，开腹组分别为（2812.43±702.48）ng/ml 、（168.40±47.19）ng/ml、（61.45±15.44）pg/ml、（104.46±15.96）pg/ml，差异有统计学意义（P<0.05）。腹腔镜组术后1年、3年、5年生存率为96.49%、83.64%、60.87%，与开腹组的94.55%、80.77%、59.52%比较，差异无统计学意义（P>0.05），且两组的术后平均生存时间比较，差异无统计学意义（P>0.05）；腹腔镜组与开腹组术后局部复发转移率分别为14.04%和25.45%，组间比较差异无统计学意义（P>0.05）。结论腹腔镜与开腹远端胃癌D2根治术对老年进展期胃癌的根治效果相当，而腹腔镜手术具有微创及术后康复快等优势，并可降低肿瘤微转移风险。

Abstract: Objective To investigate the clinical outcome of laparoscopic D2 radical distal gastrectomy in the treatment of elderly patients with advanced gastric cancer，and to investigate its effect on the expression of peritoneal lavage levels of dopamine Decarboxylase(DDC)，Hypoxia Inducible Factor1α(HIF1α)and serum levels of hypoxiainducible factor1α(HIF1α)，metastasis associated with colon cancer 1(MACC1).Methods 120 cases of elderly patients with advanced gastric cancer undergoing radical gastrectomy were divided into laparoscopic group(n=60)and open group(n=60)，patients received laparoscopic and open D2 radical distal gastrectomy respectively in the two groups.The perioperative conditions，survival，recurrence and metastasis rate between the two groups were compared.The serum levels of HIF1α，MACC1 and peritoneal lavage levels of CEA and DDC were measured preoperatively and postoperatively.Results The operative time，number of lymph nodes dissected,length of proximal margin to the cancer，length of distal margin to the cancer and postoperative complication rates in laparoscopic group〖LM〗were(163.05±15.41)min，26.89±4.55，(7.04±1.13)cm，(6.13±1.04)cm and 3.33%，respectively，which were no significant differences with open group[(158.23±13.44)min，28.41±5.23，(7.22±1.28)cm，(6.02±1.13)cm，11.67%](P>0.05).The length of incision，intraoperative bleeding，postoperative flatus time，diet intake time，ground activity time and hospital stay in laparoscopic group were(5.23±1.26)cm，(155.01±30.21)ml，(4.12±0.65)d，(4.15±0.71)d，(2.91±0.44)d，(12.69±2.45)d，respectively ，which were significantly lower than(16.32±2.53)cm，(351.91±42.16)ml，(5.13±1.02)d，(5.22±1.14)d，(4.82±1.13)d，(18.12±4.43)d in the open group(P<0.05).The peritoneal lavage levels of CEA，DDC and serum levels of HIF1α，MACC1 after operation in laparoscopic group were(1423.49±331.56)ng/ml，(115.03±30.21)ng/ml，(45.02±10.03)pg/ml，(76.69±12.45)pg/ml,respectively ，which were significantly lower than open group[(2812.43±702.48)ng/ml，(168.40±47.19)ng/ml，(61.45±15.44)pg/ml，(104.46±15.96)pg/ml](P<0.05).The 1，3and 5year survival rates were respectively 96.49%，83.64% and 60.87% in laparoscopic group，showed no significant differences with open group(94.55%，80.77%，59.52%)(P>0.05).There was no significant difference in the average postoperative survival time between the two groups(P>0.05).The recurrence and metastasis rate was 14.04% and 25.45% in laparoscopic and open group，respectively(P>0.05).conclusion Laparoscopic and open D2 radical distal gastrectomy had similar radical effect in the treatment of elderly patients with advanced gastric cancer，while laparoscopic surgery has the advantages of minimally invasive and rapid postoperative recovery and may reduce the risk of micrometastasis.

姬乐刘涛白浪高永涛. 腹腔镜远端胃癌D2根治术对老年进展期胃癌病人CEA、DDC及血清HIF1α、MACC1的影响[J]. 临床外科杂志, 2018, 26(10): 739-743.

JI Le, LIU Tao, BAI Lang, et al. Effect of laparoscopic D2 radical distal gastrectomy on expression of peritoneal lavage levels of CEA，DDC and serum levels of HIF1α，MACC1 in elderly patients with advanced gastric cancer[J]. JOURNAL OF CLINICAL SURGERY, 2018, 26(10): 739-743.

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