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目的比较达芬奇机器人辅助胃癌根治术与腹腔镜辅助胃癌根治术近期手术疗效及对患者术后免疫功能的影响。方法回顾性分析2014年12月至2016年6月于解放军总医院普通外科住院手术治疗的胃癌患者78例的临床资料,按照手术方式分为机器人组39例,腹腔镜组39例。分析比较两组患者手术情况,术前1天及术后第1、2、3、7天外周血的淋巴细胞计数、中性粒细胞计数、中性粒细胞计数/淋巴细胞计数比值水平。结果与腹腔镜组相比,机器人组术中出血量少、手术时间长、住院费用高(P<0.05,P<0.01)。两组淋巴结清扫数目、近端切缘距肿瘤距离、远端切缘距肿瘤距离、术后排气时间、术后进流食时间、术后住院时间相近(P均>0.05)。两组术前1天中性粒细胞计数、淋巴细胞计数均在正常范围内。两组中性粒细胞计数、中性粒细胞计数/淋巴细胞计数比值术后第1、2、3、7天均较术前1天明显升高(P均<0.05),淋巴细胞计数较术前1天明显下降(P均<0.05);中性粒细胞计数、中性粒细胞计数/淋巴细胞计数比值在术后第1天达到峰值,淋巴细胞计数在术后第1天降到最低值;术后同一时点,两组患者中性粒细胞计数、中性粒细胞计数/淋巴细胞计数比值、淋巴细胞计数差异无统计学意义(P均>0.05)。结论机器人辅助与腹腔镜辅助胃癌根治术相比,术中出血量少,手术效果相近,手术时间稍长,住院费用高,术后引起的免疫抑制程度相近。
Objective To compare the effect of recent operation of da Vinci robot-assisted radical gastrectomy and laparoscopic-assisted radical gastrectomy on postoperative immune function. Methods The clinical data of 78 patients with gastric cancer admitted to General Surgery General Hospital of Chinese PLA General Hospital from December 2014 to June 2016 were retrospectively analyzed. According to the surgical methods, 39 patients were divided into robotic group and 39 laparoscopic group. The levels of peripheral blood lymphocyte count, neutrophil count and neutrophil count / lymphocyte count at 1 day before operation and at 1, 2, 3 and 7 days after operation were analyzed. Results Compared with laparoscopic group, the robotic group had less blood loss, longer operation time and higher hospitalization cost (P <0.05, P <0.01). The number of lymph node dissection between the two groups, the distance from the proximal cutting edge to the tumor, the distance from the distal cutting edge to the tumor, the time of postoperative exhaust, the time of feeding after surgery, and the postoperative hospital stay were similar (all P> 0.05). The neutrophil count and lymphocyte count of the two groups were within the normal range on the 1st day before operation. The neutrophil count / neutrophil count / lymphocyte count ratio in the two groups were significantly higher than those on the 1st, 2nd, 3rd, 7th day postoperatively (all P <0.05), and the lymphocyte counts (P <0.05). The ratio of neutrophil count to neutrophil count to lymphocyte count peaked on the first postoperative day, and the lymphocyte count decreased to the lowest value on the first postoperative day There was no significant difference in neutrophil count, neutrophil count / lymphocyte count and lymphocyte count between the two groups at the same time point after operation (all P> 0.05). Conclusion Compared with laparoscopic-assisted radical gastrectomy, robotic assisted surgery has less intraoperative blood loss, similar operative results, longer operative time, higher hospitalization costs, and similar postoperative immunosuppression.