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目的分析腹腔镜辅助下食管癌根治术对患者恢复情况及凝血功能的影响。方法行食管癌根治术的患者66例,按手术方式分为腹腔镜组与开放组,其中32例在腹腔镜辅助下行开胸治疗,34例行常规手术治疗,分别比较两组患者手术时间、术中失血量、术后首次排气时间、术后平均住院时间、淋巴结清扫总数及术后并发症情况;并统计分析两组患者术前、术后6小时、术后24小时两组患者血清的活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)、D二聚体(D-D)水平。结果腹腔镜组手术时间长于开放组,但开放组术中失血量、术后首次排气时间及术后平均住院时间方面均多于或长于腹腔镜组(P<0.01),两组淋巴结清扫总数比较差异无统计学意义(P>0.05)。术后两组患者APTT、PT水平较术前明显降低,且腹腔镜组降低程度明显大于开腹组(P<0.05);两组患者术后FIB、D—D水平较术前明显升高(P<0.05),且腹腔镜组升高程度明显大于开腹组(P<0.05)。结论腹腔镜辅助下食管癌根治术具有创伤小、恢复快、术后机体应激反应程度轻等优点,但其对患者的凝血功能影响更大,应在围手术期采取相应的预防措施。
Objective To analyze the effect of laparoscopic-assisted radical resection of esophageal carcinoma on the recovery and coagulation function of patients. Methods Sixty-six patients undergoing esophageal cancer radical mastectomy were divided into laparoscopic group and open group according to the operation method. Thirty-two patients underwent laparoscopic assisted thoracotomy and 34 underwent conventional surgery. The operative time, Intraoperative blood loss, the first postoperative exhaust time, postoperative average length of stay, total lymph node dissection and postoperative complications; and statistical analysis of two groups of patients before surgery, 6 hours after surgery, 24 hours after surgery in both serum Activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen (FIB), D dimer (DD) levels. Results The operation time of laparoscopic group was longer than that of open group, but the blood loss, the time of first extubation after operation and the average length of stay after laparoscopic surgery were both longer and longer than those of laparoscopic group (P <0.01). The total number of lymph node dissection The difference was not statistically significant (P> 0.05). The postoperative APTT and PT levels in both groups were significantly lower than those before operation, and the degree of reduction in laparoscopic group was significantly higher than that in open group (P <0.05). The postoperative FIB and D-D levels in both groups were significantly higher than those before operation P <0.05), and laparoscopic group was significantly higher than the open group (P <0.05). Conclusions Laparoscopic assisted radical resection of esophageal carcinoma has the advantages of less trauma, faster recovery and less postoperative stress response, but it has a greater impact on the coagulation function of patients. Corresponding preventive measures should be taken during perioperative period.