腹腔鏡手術(shù)與傳統(tǒng)開腹手術(shù)對(duì)胃腸腫瘤患者的臨床療效及血凝狀態(tài)觀察

陳福森+夏恒+邱海江

【摘要】 目的 對(duì)比分析腹腔鏡手術(shù)與傳統(tǒng)開腹手術(shù)治療胃腸腫瘤的臨床療效及對(duì)患者血凝狀態(tài)的影響。方法 154例胃腸腫瘤患者， 隨機(jī)分為觀察組和對(duì)照組， 每組77例。對(duì)照組采用傳統(tǒng)開腹手術(shù)進(jìn)行治療， 觀察組采用腹腔鏡手術(shù)進(jìn)行治療。對(duì)比兩組患者的臨床效果、活化部分凝血活酶時(shí)間（APTT）、凝血酶原時(shí)間（PT）指標(biāo)等。結(jié)果 觀察組手術(shù)時(shí)間短于對(duì)照組、術(shù)中出血量少于對(duì)照組、排氣時(shí)間短于對(duì)照組， 并發(fā)癥發(fā)生率低于對(duì)照組， 差異均具有統(tǒng)計(jì)學(xué)意義 （t=21.442、43.149、35.864， χ2=9.606， P<0.05）。術(shù)前， 兩組患者的PT、APTT對(duì)比， 差異均無統(tǒng)計(jì)學(xué)意義（P>0.05）；術(shù)后24 h， 兩組患者的PT均較本組術(shù)前降低， 且觀察組降低程度優(yōu)于對(duì)照組， 差異均具有統(tǒng)計(jì)學(xué)意義 （P<0.05）； 術(shù)后24 h， 兩組患者的APTT均較本組術(shù)前降低， 且觀察組降低程度優(yōu)于對(duì)照組， 但差異均無統(tǒng)計(jì)學(xué)意義（P>0.05）。結(jié)論 對(duì)于胃腸腫瘤患者， 采用腹腔鏡手術(shù)在創(chuàng)傷性及并發(fā)癥方面優(yōu)于開腹手術(shù)， 但在血凝方面， 兩種治療方法均出現(xiàn)高凝狀態(tài)， 且腹腔鏡方法較為明顯；在臨床實(shí)踐中應(yīng)根據(jù)患者的身體狀態(tài)選擇合適的治療方法。

【關(guān)鍵詞】 腹腔鏡；開腹；胃腸腫瘤；血凝

DOI：10.14163/j.cnki.11-5547/r.2017.26.006

【Abstract】 Objective To compare and analyze the clinical efficacy of laparoscopic surgery and traditional laparotomy for gastrointestinal neoplasms patients， and its influence on blood coagulation status. Methods A total of 154 gastrointestinal neoplasms patients were randomly divided into observation group and control group， with 77 cases in each group. The control group was treated with traditional laparotomy， and the observation group was treated with laparoscopic surgery. Comparison were made on clinical effect， activated partial thromboplastin time （APTT） and prothrombin time （PT） in two groups. Results The observation group had shorter operation time than the control group， less intraoperative bleeding volume than the control group， shorter exhaust time than the control group and lower incidence of complications than the control group. Their difference was statistically significant （t=21.442， 43.149， 35.864， χ2=9.606， P<0.05）. Before operation， both groups had no statistically significant difference in PT and APTT （P>0.05）. In postperative 24 h， both groups had lower PT than before operation， and the observation group had better decline degree than the control group. Their difference was statistically significant （P<0.05）. In postperative 24 h， both groups had lower APTT than before operation， and the observation group had better decline degree than the control group. Their difference was not statistically significant （P>0.05）. Conclusion For gastrointestinal neoplasms， laparoscopic surgery is superior in traumatic and complications to laparotomy. But in blood coagulation， both treatments were hypercoagulable， and laparoscopic method is more obvious. Appropriate treatment method should be chosen according to patients physical condition.

【Key words】 Laparoscopic； Laparotomy； Gastrointestinal neoplasms； Blood coagulation

據(jù)我國衛(wèi)生組織統(tǒng)計(jì)， 我國腫瘤患者高達(dá)1000多萬， 惡性腫瘤中由于沒有及時(shí)治療而導(dǎo)致病情惡化危及生命約為100多萬， 由于治療方法不當(dāng)致死患者每年高達(dá)2萬左右[1]。所以， 適當(dāng)?shù)闹委煼椒▽?duì)于疾病的治療至關(guān)重要。胃腸腫瘤多為惡性腫瘤， 如不選擇合適治療方法， 生命隨時(shí)受威脅[2]。目前， 臨床上治療惡性腫瘤方法主要是外科手術(shù)法， 傳統(tǒng)以開腹手術(shù)為主， 但其手術(shù)時(shí)間一般較長， 操作較復(fù)雜， 患者多承受不了這種高強(qiáng)度手術(shù)， 使得傳統(tǒng)的開腹手術(shù)存在一定的局限性[3]。……