6孔法腹腔镜全胃根治性切除术的应用体会
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摘要
目的:探讨6孔法腹腔镜全胃根治性切除术的可行性及优势。方法:回顾分析2016年3月至2017年9月为29例患者行6孔法腹腔镜全胃根治性切除术(观察组)的临床资料,另随机抽取29例同期接受传统5孔法腹腔镜全胃根治性切除术的患者作为对照组,对比两组淋巴结清扫数量、住院时间、住院费用、手术时间及术后并发症。结果:两组淋巴结清扫数量、住院时间、住院费用及术后并发症发生率差异无统计学意义(P>0.05);观察组手术时间短于对照组,差异有统计学意义(P<0.05)。结论:6孔法腹腔镜全胃根治性切除术可增加手术视野的显露,提高手术质量,加强助手的配合,从而缩短手术时间,使专科医生的手术技能提高,且不会增加术后并发症发生率,在具有腹腔镜胃癌手术经验的单位开展是安全、可行的。
Objective: To explore the feasibility and advantages of 6-port laparoscopic total gastrectomy. Methods: Clinical data of 29 patients undergoing 6-port laparoscopic radical gastrectomy from Mar. 2016 to Sep. 2017 were retrospectively analyzed. 29 patients who received traditional 5-port method in the same period were randomly selected as control group. The clinical data were compared between the two groups in number of lymph node harvested,hospital stay,hospitalization costs,operation time and postoperative complications. Results: There was no significant difference in the number of lymph node harvested,hospital stay,hospitalization costs or incidence of postoperative complications between the two groups( P > 0. 05). The operative time of 6-port procedure was shorter than that of the 5-port method,the difference was statistically significant( P < 0. 05). Conclusions: The 6-port laparoscopic radical gastrectomy can increase the exposure of surgical visual field,improve the quality of operation,and strengthen the cooperation of assistants,thus shortens the operation time,improves the surgical skills of specialists,and does not increase postoperative complications. It is safe and feasible in units that have experiences of laparoscopic surgery for gastric cancer.
Objective: To explore the feasibility and advantages of 6-port laparoscopic total gastrectomy. Methods: Clinical data of 29 patients undergoing 6-port laparoscopic radical gastrectomy from Mar. 2016 to Sep. 2017 were retrospectively analyzed. 29 patients who received traditional 5-port method in the same period were randomly selected as control group. The clinical data were compared between the two groups in number of lymph node harvested,hospital stay,hospitalization costs,operation time and postoperative complications. Results: There was no significant difference in the number of lymph node harvested,hospital stay,hospitalization costs or incidence of postoperative complications between the two groups( P > 0. 05). The operative time of 6-port procedure was shorter than that of the 5-port method,the difference was statistically significant( P < 0. 05). Conclusions: The 6-port laparoscopic radical gastrectomy can increase the exposure of surgical visual field,improve the quality of operation,and strengthen the cooperation of assistants,thus shortens the operation time,improves the surgical skills of specialists,and does not increase postoperative complications. It is safe and feasible in units that have experiences of laparoscopic surgery for gastric cancer.
引文
[1]Chen W,Zheng R,Baade PD,et al.Cancer statistics in China,2015[S].CA Cancer J Clin,2016,66(2):115-132.
[2]Memon MA,Khan S,Yunus RM,et al.Meta-analysis of laparoscopic and open distal gastrectomy for gastric carcinoma[J].Surg Endosc,2008,22(8):1781-1789.
[3]李国新,胡彦锋,刘浩.中国腹腔镜胃肠外科研究组CLASS-01研究进展[J].中华消化外科杂志,2017,16(1):38-42.
[4]Japanese Gastric Cancer Association.Japanese gastric cancer treatment guidelines 2014(ver.4)[S].Gastric Cancer,2017,20(1):1-19.
[5]Son SY,Cui LH,Shin HJ,et al.Modified overlap method using knotless barbed sutures(MOBS)for intracorporeal esophagojejunostomy after totally laparoscopic gastrectomy[J].Surg Endosc,2017,31(6):2697-2704.
[6]Jeong O,Jung MR,Kim GY,et al.Comparison of short-term surgical outcomes between laparoscopic and open total gastrectomy for gastric carcinoma:case-control study using propensity score matching method[J].J Am Coll Surg,2013,216(2):184-191.
[7]黄智清,李国新,许燕常,等.腹腔镜辅助D2根治性全胃切除术与传统开腹手术的比较研究[J].中华胃肠外科杂志,2014,17(8):781-784.
[8]李国新.中国腹腔镜胃癌外科临床研究现状[J].中华消化外科杂志,2016,15(1):27-30.
[9]Yoshikawa T,Murai S,Imai S,et al.Short-term outcomes of reduced port laparoscopy-assisted total gastrectomy[J].Gan To Kagaku Ryoho,2013,40(12):2295-2297.
[10]Omori T,Fujiwara Y,Moon J,et al.Comparison of Single-Incision and Conventional Multi-Port Laparoscopic Distal Gastrectomy with D2 Lymph Node Dissection for Gastric Cancer:A Propensity Score-Matched Analysis[J].Ann Surg Oncol,2016,23(Suppl5):817-824.
[11]张泽,王亚楠,李国新.经自然孔道内镜手术临床研究现状及展望[J].中国实用外科杂志,2015,35(12):1363-1366.
[12]胡三元.经自然腔道内镜手术与腹腔镜单孔手术[J/CD].中华腔镜外科杂志(电子版),2010,3(1):11-15.
[2]Memon MA,Khan S,Yunus RM,et al.Meta-analysis of laparoscopic and open distal gastrectomy for gastric carcinoma[J].Surg Endosc,2008,22(8):1781-1789.
[3]李国新,胡彦锋,刘浩.中国腹腔镜胃肠外科研究组CLASS-01研究进展[J].中华消化外科杂志,2017,16(1):38-42.
[4]Japanese Gastric Cancer Association.Japanese gastric cancer treatment guidelines 2014(ver.4)[S].Gastric Cancer,2017,20(1):1-19.
[5]Son SY,Cui LH,Shin HJ,et al.Modified overlap method using knotless barbed sutures(MOBS)for intracorporeal esophagojejunostomy after totally laparoscopic gastrectomy[J].Surg Endosc,2017,31(6):2697-2704.
[6]Jeong O,Jung MR,Kim GY,et al.Comparison of short-term surgical outcomes between laparoscopic and open total gastrectomy for gastric carcinoma:case-control study using propensity score matching method[J].J Am Coll Surg,2013,216(2):184-191.
[7]黄智清,李国新,许燕常,等.腹腔镜辅助D2根治性全胃切除术与传统开腹手术的比较研究[J].中华胃肠外科杂志,2014,17(8):781-784.
[8]李国新.中国腹腔镜胃癌外科临床研究现状[J].中华消化外科杂志,2016,15(1):27-30.
[9]Yoshikawa T,Murai S,Imai S,et al.Short-term outcomes of reduced port laparoscopy-assisted total gastrectomy[J].Gan To Kagaku Ryoho,2013,40(12):2295-2297.
[10]Omori T,Fujiwara Y,Moon J,et al.Comparison of Single-Incision and Conventional Multi-Port Laparoscopic Distal Gastrectomy with D2 Lymph Node Dissection for Gastric Cancer:A Propensity Score-Matched Analysis[J].Ann Surg Oncol,2016,23(Suppl5):817-824.
[11]张泽,王亚楠,李国新.经自然孔道内镜手术临床研究现状及展望[J].中国实用外科杂志,2015,35(12):1363-1366.
[12]胡三元.经自然腔道内镜手术与腹腔镜单孔手术[J/CD].中华腔镜外科杂志(电子版),2010,3(1):11-15.