The clinical effect of laparoscopic and open surgery in treatment of gastric cancer and their effect on the blood coagulation state_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 XU Qiyin , HUANG Jun , CHEN Weiping

Department of General Surgery, The First People’s Hospital of Yibin, Yibin, Sichuan 644000, P.R.China;

Corresponding?author：

XU Qiyin, Email: xuqiyin8802@126.com

Keywords：

gastric cancer; laparoscopy; open surgery; blood coagulation state

DOI：

10.7507/1007-9424.201607083

Video：

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Objective To compare the effect of laparoscopic surgery and open surgery on the blood coagulation state in patients with gastric cancer, and to provide evidence for the prevention measurement of thrombosis in perioperative period. Methods One hundred patients with gastric cancer who received treatment in our hospital from Feb. 2014 to Aug. 2014, were randomly divided into laparoscopy group and laparotomy group, 50 patients in each group. The patients in laparotomy group were treated by traditionally open surgery, while patients in the laparoscopy group accepted laparoscopic surgery. The clinically therapeutic effect of 2 groups was compared. Results ① Operative indexes. The operation time, blood loss, anal exhaust time, hospital stay, and morbidity of laparoscopy group were all lower than those of laparotomy group (P<0.05). ② Coagulation function. Compared with preoperative indexes, the prothrombin time (PT) at 24 h after operation in laparoscopy group and laparotomy group were both shorter (P<0.05), but there was no significant difference in activated partial thromboplastin time (APTT) and international normalized ratio (INR) between the 2 time points (before operation and 24 h after operation) in both 2 groups (P>0.05). Both at 2 time points (before operation and 24 h after operation), there was no significant difference in PT, APTT, and INR between 2 groups (P>0.05). ③ Fibrinolysis indexes. Compared with preoperative indexes, the fibrinogen (FIB) and D-dimer at 24 h after operation in laparoscopy group and laparotomy group were higher (P<0.05). The FIB and D-dimer at 24 h after operation in laparoscopy group were both higher than those of laparotomy group (P<0.05). ④ Follow-up results. There was no significant difference in metastasis rate, recurrence rate, and mortality between the 2 groups (P>0.05), but the incidence of thrombus was higher in laparoscopy group than that of laparotomy group (P<0.05). Conclusions In the treatment of patients with gastric cancer, laparoscopic surgery has the advantages of less trauma, less blood loss, less complications, and so on. Laparoscopic surgery and open surgery both can lead to hypercoagulable state, but the effect of laparoscopic surgery is stronger than open surgery.

Citation： XU Qiyin, HUANG Jun, CHEN Weiping. The clinical effect of laparoscopic and open surgery in treatment of gastric cancer and their effect on the blood coagulation state. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(6): 716-721. doi: 10.7507/1007-9424.201607083 Copy

1.	孫惠東. 腹腔鏡治療良性胃腸腫瘤臨床療效觀察.世界最新醫學信息文摘(電子版), 2015, 9(67): 60-61.
2.	馬紅滔, 常曉健, 趙相軍, 等. 腹腔鏡手術患者術后下肢深靜脈血栓形成的危險因素. 中國實用醫藥, 2014, 9(8): 99-101.
3.	徐繼, 吳浩, 葉再元, 等. 腹腔鏡與開腹手術治療胃腸道間質瘤的療效及對外周血凝血功能影響的對比研究. 中國醫師雜志, 2015, 17(5): 660-663.
4.	羅利民, 胡明. 腹腔鏡與開腹胃癌切除手術前后凝血和纖溶分子標志物變化的對比研究. 中國現代醫生, 2014, 52(13): 127-129.
5.	朱紹華. 腹腔鏡手術與傳統開腹手術對胃腸腫瘤患者的臨床療效及血凝狀態的影響. 中華普通外科學文獻(電子版), 2015, 12(4): 307-310.
6.	胡筱壯. 胃腸腫瘤患者腹腔鏡手術后臨床療效觀察及其對血凝狀態的影響研究. 中國現代手術學雜志, 2014, 18(2): 108-111.
7.	瞿昌晶, 楊力, 郭旋, 等. 腹腔鏡手術后下肢深靜脈血栓形成的相關因素分析. 中國基層醫藥, 2015, 22(6): 902-904.
8.	鄒小農, 孫喜斌, 陳萬青, 等. 2003–2007 年中國胃癌發病與死亡情況分析. 腫瘤, 2012, 32(2): 109-114.
9.	熊文俊, 王亞楠, 李國新. 單孔腹腔鏡結直腸手術的應用進展. 南方醫科大學學報, 2014, 34(4): 576-581.
10.	田瑞, 高素艷. 婦科腹腔鏡術后下肢深靜脈血栓形成臨床分析. 臨床軍醫雜志, 2012, 40(4): 962-964.
11.	朱紅亞, 張遂, 趙強, 等. 腹腔鏡結腸癌手術對患者凝血狀態的影響. 中國現代普通外科進展, 2011, 14(4): 331-332.
12.	楊立, 羅曉華, 王冰冰, 等. 腹腔鏡下子宮全切術后下肢靜脈血栓形成 17 例臨床分析. 中國內鏡雜志, 2013, 19(6): 649-651.
13.	王梅, 王金良. D-二聚體檢測的臨床應用進展. 國際檢驗醫學雜志, 2011, 32(1): 82-84.
14.	郝青, 王晶, 李衛軍, 等. 二氧化碳氣腹時間對老年腹腔鏡膽囊切除術患者凝血-纖溶和血管內皮細胞活性的影響. 中國老年學雜志, 2015, 35(2): 333-335.
15.	Scurlock C, Raikhelkar J, Mechanick JI, et al. Impact of new technologies on metabolic care in the intensive care unit. Curr Opin Clin Nutr Metab Care, 2009, 12(2): 196-200.
16.	嚴美娟, 樓小侃, 陳悅, 等. 不同二氧化碳氣腹時間膽囊切除術患者凝血纖溶功能和血管內膜損傷的比較. 中華麻醉學雜志, 2011, 31(3): 299-302.
17.	韓璐, 戴廣海, 孫剛, 等. 70 歲以上老年胃癌患者臨床特點及預后. 胃腸病學和肝病學雜志, 2012, 21(1): 42-46.
18.	胡苗苗, 包永星, 趙化榮, 等. 老年胃癌患者預后因素分析. 中國全科醫學, 2011, 14(18): 2010-2013.
19.	朱才秀, 張銳利, 姚永庭. 全胃切除、改良 Double tract 代胃術治療老年胃癌的臨床研究. 浙江創傷外科, 2014, (2): 284-286.
20.	代敏, 任建松, 李霓, 等. 中國 2008 年腫瘤發病和死亡情況估計及預測. 中華流行病學雜志, 2012, 33(1): 57-61.
21.	Yoo CH, Noh SH, Kim YI, et al. Comparison of prognostic significance of nodal staging between old (4^th edition) and new (5^th edition) UICC TNM classification for gastric carcinoma. International Union Against Cancer. World J Surg, 1999, 23(5): 492-498.
22.	Johnson AT, Kaufmann Y, Luo S, et al. Gut glutathione metabolism and changes with 7,12-DMBA and glutamine. J Surg Res, 2003, 115(2): 242-246.
23.	Gur AS, Atahan K, Aladag I, et al. The efficacy of Nutrition Risk Screening-2002 (NRS-2002) to decide on the nutritional support in general surgery patients. Bratisl Lek Listy, 2009, 110(5): 290-292.
24.	Braga M, Gianotti L, Vignali A, et al. Immunonutrition in gastric cancer surgical patients. Nutrition, 1988, 14(11-12): 831-835.
25.	Ravasco P, Monteiro-Grillo I, Marques Vidal P, et al. Impact of nutrition on outcome: a prospective randomized controlled trial in patients with head and neck cancer undergoing radiotherapy. Head Neck, 2005, 27(8): 659-668.
26.	Parkin DM, Bray F, Ferlay J, et al. Global cancer statisties 2002. CA Cancer J Din, 2010, 55(5): 74-78.
27.	Kim SD, Kim HS. Effects of a relaxation breathing exercise on anxiety, depression, and leukocyte in hemopoietic stem cell transplantation patients. Cancer Nurs, 2005, 28(1): 79-83.

1. 孫惠東. 腹腔鏡治療良性胃腸腫瘤臨床療效觀察.世界最新醫學信息文摘(電子版), 2015, 9(67): 60-61.
2. 馬紅滔, 常曉健, 趙相軍, 等. 腹腔鏡手術患者術后下肢深靜脈血栓形成的危險因素. 中國實用醫藥, 2014, 9(8): 99-101.
3. 徐繼, 吳浩, 葉再元, 等. 腹腔鏡與開腹手術治療胃腸道間質瘤的療效及對外周血凝血功能影響的對比研究. 中國醫師雜志, 2015, 17(5): 660-663.
4. 羅利民, 胡明. 腹腔鏡與開腹胃癌切除手術前后凝血和纖溶分子標志物變化的對比研究. 中國現代醫生, 2014, 52(13): 127-129.
5. 朱紹華. 腹腔鏡手術與傳統開腹手術對胃腸腫瘤患者的臨床療效及血凝狀態的影響. 中華普通外科學文獻(電子版), 2015, 12(4): 307-310.
6. 胡筱壯. 胃腸腫瘤患者腹腔鏡手術后臨床療效觀察及其對血凝狀態的影響研究. 中國現代手術學雜志, 2014, 18(2): 108-111.
7. 瞿昌晶, 楊力, 郭旋, 等. 腹腔鏡手術后下肢深靜脈血栓形成的相關因素分析. 中國基層醫藥, 2015, 22(6): 902-904.
8. 鄒小農, 孫喜斌, 陳萬青, 等. 2003–2007 年中國胃癌發病與死亡情況分析. 腫瘤, 2012, 32(2): 109-114.
9. 熊文俊, 王亞楠, 李國新. 單孔腹腔鏡結直腸手術的應用進展. 南方醫科大學學報, 2014, 34(4): 576-581.
10. 田瑞, 高素艷. 婦科腹腔鏡術后下肢深靜脈血栓形成臨床分析. 臨床軍醫雜志, 2012, 40(4): 962-964.
11. 朱紅亞, 張遂, 趙強, 等. 腹腔鏡結腸癌手術對患者凝血狀態的影響. 中國現代普通外科進展, 2011, 14(4): 331-332.
12. 楊立, 羅曉華, 王冰冰, 等. 腹腔鏡下子宮全切術后下肢靜脈血栓形成 17 例臨床分析. 中國內鏡雜志, 2013, 19(6): 649-651.
13. 王梅, 王金良. D-二聚體檢測的臨床應用進展. 國際檢驗醫學雜志, 2011, 32(1): 82-84.
14. 郝青, 王晶, 李衛軍, 等. 二氧化碳氣腹時間對老年腹腔鏡膽囊切除術患者凝血-纖溶和血管內皮細胞活性的影響. 中國老年學雜志, 2015, 35(2): 333-335.
15. Scurlock C, Raikhelkar J, Mechanick JI, et al. Impact of new technologies on metabolic care in the intensive care unit. Curr Opin Clin Nutr Metab Care, 2009, 12(2): 196-200.
16. 嚴美娟, 樓小侃, 陳悅, 等. 不同二氧化碳氣腹時間膽囊切除術患者凝血纖溶功能和血管內膜損傷的比較. 中華麻醉學雜志, 2011, 31(3): 299-302.
17. 韓璐, 戴廣海, 孫剛, 等. 70 歲以上老年胃癌患者臨床特點及預后. 胃腸病學和肝病學雜志, 2012, 21(1): 42-46.
18. 胡苗苗, 包永星, 趙化榮, 等. 老年胃癌患者預后因素分析. 中國全科醫學, 2011, 14(18): 2010-2013.
19. 朱才秀, 張銳利, 姚永庭. 全胃切除、改良 Double tract 代胃術治療老年胃癌的臨床研究. 浙江創傷外科, 2014, (2): 284-286.
20. 代敏, 任建松, 李霓, 等. 中國 2008 年腫瘤發病和死亡情況估計及預測. 中華流行病學雜志, 2012, 33(1): 57-61.
21. Yoo CH, Noh SH, Kim YI, et al. Comparison of prognostic significance of nodal staging between old (4^th edition) and new (5^th edition) UICC TNM classification for gastric carcinoma. International Union Against Cancer. World J Surg, 1999, 23(5): 492-498.
22. Johnson AT, Kaufmann Y, Luo S, et al. Gut glutathione metabolism and changes with 7,12-DMBA and glutamine. J Surg Res, 2003, 115(2): 242-246.
23. Gur AS, Atahan K, Aladag I, et al. The efficacy of Nutrition Risk Screening-2002 (NRS-2002) to decide on the nutritional support in general surgery patients. Bratisl Lek Listy, 2009, 110(5): 290-292.
24. Braga M, Gianotti L, Vignali A, et al. Immunonutrition in gastric cancer surgical patients. Nutrition, 1988, 14(11-12): 831-835.
25. Ravasco P, Monteiro-Grillo I, Marques Vidal P, et al. Impact of nutrition on outcome: a prospective randomized controlled trial in patients with head and neck cancer undergoing radiotherapy. Head Neck, 2005, 27(8): 659-668.
26. Parkin DM, Bray F, Ferlay J, et al. Global cancer statisties 2002. CA Cancer J Din, 2010, 55(5): 74-78.
27. Kim SD, Kim HS. Effects of a relaxation breathing exercise on anxiety, depression, and leukocyte in hemopoietic stem cell transplantation patients. Cancer Nurs, 2005, 28(1): 79-83.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The clinical effect of laparoscopic and open surgery in treatment of gastric cancer and their effect on the blood coagulation state

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