| Background: In my country,gastric cancer is one of the most common malignant tumors of the digestive system,and its incidence is increasing year by year.Surgical treatment is currently the most effective way to treat gastric cancer,including traditional open surgery and laparoscopic surgery.Compared with traditional radical gastrectomy for gastric cancer,laparoscopic radical gastrectomy has the advantages of less invasive surgery,less intraoperative bleeding,less postoperative complications,faster recovery,and significantly shorter postoperative hospital stay.Deep vein thrombosis is one of the common complications of gastric cancer surgery.According to previous studies,the incidence of deep vein thrombosis in patients with gastric cancer is 9.5%.Pulmonary embolism is a serious postoperative fatal complication.About 80% of pulmonary embolisms are caused by deep vein thrombosis of the lower extremities.The analysis of the formation and causes of deep vein thrombosis of lower extremities after radical surgery of gastric cancer with different surgical methods is of great significance for the correct selection of reasonable gastric cancer surgical methods and the reduction of serious complications after gastric cancer surgery.Objective: This study intends to compare the effects of laparoscopic radical gastric cancer surgery and open radical gastric cancer radical surgery on the deep venous hemodynamics and coagulation function of gastric cancer patients after surgery,and further explore the specificity of the two surgical methods and the venous thrombosis of the lower limbs Relationship,and to assess the changes in the patient’s overall quality of life after the two procedures,and to analyze the factors that affect the patient’s DVT during the perioperative period.This provides a clinical idea and theoretical basis for the choice of radical gastrectomy and how to better prevent the occurrence of deep vein thrombosis.Methods: 134 patients with gastric cancer who had complete data from June 2016 to February 2018 who were admitted to Shanghai Oriental Hepatobiliary Surgery Hospital and Tongren Hospital Affiliated to Shanghai Jiaotong University School of Medicine were selected and treated.The patients were divided into two groups according to different surgical methods: 72 cases in the laparoscopic assisted radical surgery for gastric cancer(laparoscopic radical surgery group)and 62 cases in the traditional radical surgery for gastric cancer(traditional radical surgery group for gastric cancer).Observe and record the patient’s hemodynamic indicators before and during the operation in detail: observe the femoral vein blood flow velocity(v),left lower limb femoral vein diameter(r)and femoral vein blood flow(Q);observe and record Blood clotting related indicators before,immediately after surgery,3 days after surgery,and 7 days after surgery: including prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB),DDimer(DD)and Prothrombin International Normalized Value(INR).Record the number and incidence of Deep Venous Thrombosis(DVT)within 7 days after operation;compare the difference in the rates of DVT between the two groups;explore the impact on postoperative stress response and cellular immune function: compare the two groups Stress indicators [malondialdehyde(MDA),superoxide dismutase(SOD),IL-6,CRP] and cellular immune function indicators(CD4 +,CD8 +,CD4 + / CD8 +)level;further use Gastrointestinal Quality Life Index(GQLI)to evaluate the subjective symptoms,social activity function,physiological function status,psychological status of the two groups of gastric cancer patients before and 1 month after operation Emotional state,and further use the GQLI scale score to comprehensively score the patient’s condition.Finally,the related risk factors that affect the formation of postoperative DVT are discussed.Results: 1.1.The general clinical data of the two groups of gastric cancer patients showed no significant difference in clinical data(P>0.05);1.2.In the intraoperative recording of data,the laparoscopic gastric cancer radical surgery group took longer than traditional surgery Open radical surgery group(P<0.05).1.3 According to the comparison of the intraoperative blood loss records,the intraoperative blood loss in the laparoscopic gastric cancer radical surgery group was less than that in the traditional laparoscopic gastric cancer radical surgery group(P<0.05).1.4.In terms of patient recovery,the postoperative hospital stay in the laparoscopic gastric cancer radical surgery group was shorter than that in the traditional laparoscopic gastric cancer radical surgery group(P<0.05);1.5.In the laparoscopic gastric cancer radical surgery group,compared with before pneumoperitoneum establishment,the abdominal cavity In the radical gastrectomy group,the diameter of the femoral vein in the supine position after pneumoperitoneum increased,the average blood flow rate slowed,and the blood flow in the femoral vein decreased.The difference was statistically significant(P<0.05);compared with the supine position after pneumoperitoneum In the laparoscopic gastrectomy group,the diameter of the femoral vein was reduced before the anesthesia was restored,the average blood flow rate was accelerated,and the blood flow of the femoral vein was increased.The difference was statistically significant(P<0.05);Compared with the traditional laparoscopic gastric cancer radical surgery group before the recovery of anesthesia,the laparoscopic gastric cancer radical surgery group before the recovery of anesthesia has a larger femoral vein diameter,slower average blood flow velocity,and less femoral vein blood flow,and the difference It is statistically significant(P<0.05).1.6.At 3 days after surgery,the PT of the two groups was significantly shortened,which was significantly different from that immediately after the operation(P<0.05),but there was no significant difference between the two groups(P>0.05).The postoperative APTT and the immediate postoperative period of the two groups were significantly shorter than those before the operation,and the difference was statistically significant(P<0.05).Among them,the 3 days and 7 days of the traditional radical gastric cancer radical surgery group were significantly shorter than the previous time point,the difference was statistically significant(P<0.05),but there was no significant difference between the groups(P>0.05).Compared with pre-operation,FIB increased at the end of laparoscopic gastric cancer radical surgery group and FIB at the end of traditional radical gastric cancer radical surgery group and the difference was significant(P<0.05).FIB in the two groups increased further 3 days after surgery high.Compared with the end of the operation,there was a significant difference(P<0.05).The FIB of the two groups was further increased at 7 days after the operation.Among them,the traditional radical gastric cancer surgery group had a significant difference compared to the 3 days after the operation(P<0.05),while the two groups The difference was not obvious(P>0.05).The D-D of the two groups of patients increased gradually after the operation,and the two groups increased significantly at 7 days after the operation compared to the 3 days after the operation.The differences were statistically significant(P<0.05).In the laparoscopic radical gastrectomy group,there was a significant increase immediately after the operation,3 days after the operation,and 7 days after the operation.The difference was significant(P<0.05),which was statistically significant;the difference between the two groups was not Obvious(P>0.05).2.1.Laparoscopic assisted radical surgery for gastric cancer can effectively reduce the body’s stress response and promote cellular immune function: the levels of MDA,IL-6 and CRP on the first and seventh days after surgery in both groups were significantly higher than those in the same group before surgery(P< 0.05),the level of SOD was significantly lower than that of the same group before surgery(P<0.05);the level of MDA,IL-6,CRP on the 7th day after surgery was significantly lower than that of the same group on the first day after surgery(P<0.05),The SOD level was significantly higher than that in the same group on the first postoperative day(P<0.05).The MDA levels in the laparoscopic group on the 1st and 7th days after surgery were significantly higher than those in the laparotomy group(P<0.05),and the levels of SOD,IL-6 and CRP were significantly lower than those in the laparotomy group(P<0.05).The CD4+,CD8+,CD4+/CD8+ on the 1st and 7th days after operation in both groups were significantly lower than those in the same group(P<0.05),and the CD4+ and CD8+ on the 7th day after the laparoscopic group were significantly higher than those in the same group.After the first day(P<0.05).The CD4+,CD8+,CD4+/CD8+ on the 1st and 7th day after laparoscopic group were significantly higher than those in the laparotomy group at the same time(P<0.05).2.2.The areas in the gastrointestinal quality of life index scale before operation in the two groups of patients: before operation,the patients’ subjective symptoms,social activity function,physiological function state,psychological emotional state and GQLI total score were found,There was no significant difference between the two groups(P>0.05),but the subjective symptoms,social activity function,physiological function state,psychological emotional state,and GQLI total score of gastric cancer patients after surgery decreased to varying degrees.Among them,the traditional radical gastric cancer radical surgery group was significantly lower than that before surgery,and the traditional radical gastric cancer radical surgery group was significantly lower than that after laparoscopic surgery,the difference was statistically significant(P<0.05).The incidence of DVT in the two groups was 11.1% in the laparoscopic radical gastrectomy group and 9.7% in the traditional laparoscopic radical surgery group.Compared with the traditional radical gastric cancer surgery group,the incidence of deep vein thrombosis(DVT)in the lower limbs was higher in the laparoscopic radical gastric cancer surgery group,but the difference was not statistically significant(P>0.05).3.The choice of surgical method during the perioperative period is not a risk factor for the occurrence of postoperative DVT,and patients with high blood sugar and obesity are likely to cause postoperative DVT.Patients should wear elastic stockings routinely to prevent DVT effectively.For patients ≥60 years old Anti-coagulation therapy should be performed after surgery.for obese patients younger than 60 years of age,the risk of postoperative DVT should be highly valued and early intervention should be performed.Conclusion: Compared with traditional open radical gastric cancer radical surgery,laparoscopic radical gastric cancer surgery has less bleeding during operation and quicker postoperative recovery,which can lead to increased fluctuations in the hemodynamic changes of the veins of the lower extremities;both surgical procedures can coagulate and Fibrinolysis has an effect,but there is no significant difference between the two groups;previous studies have shown that acute and chronic stress responses and the body’s cellular immune function are positively correlated with the formation of DVT.Laparoscopic assisted radical surgery for gastric cancer can effectively reduce the body’s stress response,promote cellular immune function,accelerate patients’ postoperative recovery,and reduce the risk of DVT formation;both procedures will significantly affect the physiological function and quality of life of patients with gastric cancer.However,compared with traditional laparoscopic gastric cancer surgery,the physiological function and psychological emotional state of patients undergoing laparoscopic gastric cancer surgery can be restored to a level close to that before surgery in a shorter period of time(P<0.05),and ultimately make the patient survive after surgery The quality has been significantly improved.Based on the above factors,laparoscopic surgery has a significant impact on hemodynamics,which can increase the risk of DVT formation.But it can effectively reduce the body’s stress response,promote cellular immune function,and reduce the formation of DVT.Therefore,there is no significant difference in the formation of DVT after operation between the two(P>0.05).Further analysis found that during the perioperative period,preoperative patients with high BMI and diabetes have a tendency to cause deep vein thrombosis after surgery.Postoperative elastic stockings and anticoagulation therapy after surgery can prevent patients from developing deep veins after surgery. |
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