| Objective: Comparison of the short-term clinical effects of total laparoscopy and laparoscopic-assisted radical gastrectomy for distal gastric cancer.Despite the rapid development of gene recognition and targeted therapies for gastric cancer,the only treatment option to improve survival in gastric cancer patients is surgical resection.The world mainstream laparoscopic distal gastric cancer radical surgery of the digestive tract reconstruction technique mainly has completely(TLDG)and laparoscopic distal gastric cancer radical laparoscopic assisted distal gastric cancer radical prostatectomy(LADG)two,TLDG is a kind of cavity of reconstructive surgery,can avoid additional incision in the operation,relieve pain,promote the patient recover at an early date,although scholars have related research at home and abroad,but for the safety and feasibility is still controversial.In this paper,by comparing the ERAS under the guidance of totally laparoscopic distal gastric cancer radical prostatectomy(TLDG)and traditional laparoscopic assisted distal gastric cancer radical prostatectomy(LADG)security compared with the recent prognosis,explores ERAS under the guidance of the application of laparoscopic surgery in the treatment of distal gastric cancer patients value,proved in gastric cancer surgery in the superiority of laparoscopic gastrointestinal anastomosis,promote the development of laparoscopic gastric cancer surgery and rapid rehabilitation surgery.Methods: A prospective randomized controlled clinical study was designed to include gastric cancer patients treated by gastrointestinal surgery in affiliated hospital of Qingdao university from March 2018 to October 2018.The patients were divided into TLDG group and LADG group by random number table method.Two groups of patients adopt ERAS perioperative management mode,intraoperative in complete resection of the tumor and lymph node dissection,TLDG group fully completed in laparoscopic digestive tract reconstruction,LADG group take on abdominal midline incision,the digestive tract reconstruction in vitro,in order to reduce variables,and digestive tract reconstruction methods in the two groups are using the straight-line cutting line closer BII +Brown.Observation and comparative analysis of two groups of patients in the identical time,operation time,the incision length,number of lymph node cleaning,tumor size,on the cutting edge distance,the first postoperative anal exhaust time,postoperative pain score 1,3,5 d,pain killer agent dosage,general surgery,postoperative hospital stay and postoperative complications,respectively in the preoperative and postoperative 1 day early morning,the extraction of two groups of patients with peripheral venous blood samples,on an empty stomach to detect patients with stress indicators: 8 am cortisol,8am ACTH(CRH),C-reactive protein(CRP)and white blood cells(WBC);Nutrition index(albumin,proalbumin).SPSS 22.0 statistical software was used to analyze the variance of the two groups of clinical data collected.Results: Finally,a total of 60 patients were included in the study,including 30 patients in the TLDG group and 30 patients in the LADG group.The intraoperative time of anastomosis,operation time and lymph node dissection in TLDG group were more than those in LADG group,but the difference was not statistically significant(p >0.050).There was no statistically significant difference between the two groups in tumor size and the distance of the upper incisor margin(p > 0.050).The length of the main incision in TLDG group was significantly smaller than that in LADG group(p <0.050).The first postoperative anal exhaust time in TLDG group was earlier than LADG group(p < 0.050).Postoperative hospitalization time in TLDG group was less than LADG group(p < 0.050).Hospitalization costs and surgical-related costs in TLDG group were slightly higher than those in LADG group,but the difference was not statistically significant(p > 0.050).WBC count,c-reactive protein and adrenocorticotropin levels were all lower than LADG group 1 day after surgery(p < 0.050).The total amount of postoperative analgesics and the VAS pain score of postoperative patients were smaller than LADG group(p < 0.050)at 1,3 and 5 days after surgery.LADG group had 1 case of incision infection and 1 case of early postoperative inflammatory intestinal obstruction.There was 1 case of gastroparesis in the TLDG group,without anastomotic leakage,anastomotic stenosis,bleeding,incision infection and other related complications.There was no statistically significant difference in the overall incidence of postoperative complications between the two groups(p > 0.050).Conclusions: By analyzing the clinical research can draw the following conclusion,laparoscopic assisted with laparoscope can complete standard distal gastric cancer radical,no obvious difference in cancer treatment,and compared with LADG TLDG patients with small incision,postoperative pain,reduce the postoperative stress,further shorten the postoperative hospitalization time,insure the effect of treatment in did not increase the risk of postoperative complications occurred at the same time,also did not add extra economic burden to patients,for patients with comprehensive recovery of body and mind,is suitable for clinical promotion.Although TLDG as a new technology,has a steep learning curve.Initial application requires time and energy,but with the continuous innovation of laparoscopic instruments,the improvement of laparoscopic techniques of surgeons and the accumulation of experience,total laparoscopy will definitely get more and better applications.The development of ERAS in terms of surgical methods will bring greater benefits to patients. |
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