预先小切口辅助腹腔镜远端胃癌D2根治术的临床效果观察
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摘要
目的探讨预先小切口辅助腹腔镜远端胃癌D2根治术的临床应用价值。方法回顾性分析2013年7月至2016年1月四川省人民医院收治的96例远端胃癌患者的临床资料,其中行预先小切口辅助腹腔镜远端胃癌D2根治术50例(预先小切口组),行腹腔镜小切口辅助远端胃癌D2根治术46例(辅助小切口组),对比分析两种手术方式的临床疗效。结果预先小切口组的手术时间、清扫No.4d、5、6、8、12、14v组淋巴结时间及出血量均少于辅助小切口组,差异有统计学意义(P<0.05)。两组患者术后下床活动时间,术后首次排气时间,术后住院时间及术后生存率比较,差异均无统计学意义(P>0.05)。两组手术中转开腹率,术中出血量,术中输血例数比较差异也无统计学意义(P>0.05)。结论预先小切口辅助腹腔镜远端胃癌D2根治术省时,出血少且术式简单临床应用价值大,术后总体生存率与腹腔镜辅助小切口组相似,值得推广。
Objective To explore the clinical application value of pre-small incision in laparoscopy-assisted radical gastrectomy with D_2 lymph node dissection for distal gastric cancer. Methods Clinical data of 96 cases of radical gastrectomy with D_2 lymph node dissection for distal gastric cancer from July 2013 to January 2016 in Sichuan Provincial People's Hospital were analyzed retrospectively.Among these patients,50 cases received pre-small incision in laparoscopy-assisted radical gastrectomy were defined as presmall incision group,while 46 cases received laparoscopy small incision assisted radical gastrectomy were included in assisted small incision group.Clinical efficacy of the two types of surgery was analyzed.Results The operation time,duration and amount of blood loss in the lymph node dissection of No.4 d,5,6,8,12 and 14 v in the pre-small incision group was significantly shorter or less than those in the assisted small incision group( P < 0. 05).There was no statistically significant difference among the postoperative ambulation time,anus exhaust time,postoperative hospital stay and postoperative survival rate between the two groups( P > 0. 05).There was also no statistically significant difference in the rates of conversion to laparotomy,bleeding amount during surgery and the number of blood transfusion during surgery between the two groups( P > 0. 05).Conclusion The pre-small incision-assisted laparoscopic radical gastrectomy with D_2 lymph node dissection has been proved to be a time-saving procedure with small amount of blood loss.The surgical procedure is very simple.It has great clinical value and is worthy of popularizing.
Objective To explore the clinical application value of pre-small incision in laparoscopy-assisted radical gastrectomy with D_2 lymph node dissection for distal gastric cancer. Methods Clinical data of 96 cases of radical gastrectomy with D_2 lymph node dissection for distal gastric cancer from July 2013 to January 2016 in Sichuan Provincial People's Hospital were analyzed retrospectively.Among these patients,50 cases received pre-small incision in laparoscopy-assisted radical gastrectomy were defined as presmall incision group,while 46 cases received laparoscopy small incision assisted radical gastrectomy were included in assisted small incision group.Clinical efficacy of the two types of surgery was analyzed.Results The operation time,duration and amount of blood loss in the lymph node dissection of No.4 d,5,6,8,12 and 14 v in the pre-small incision group was significantly shorter or less than those in the assisted small incision group( P < 0. 05).There was no statistically significant difference among the postoperative ambulation time,anus exhaust time,postoperative hospital stay and postoperative survival rate between the two groups( P > 0. 05).There was also no statistically significant difference in the rates of conversion to laparotomy,bleeding amount during surgery and the number of blood transfusion during surgery between the two groups( P > 0. 05).Conclusion The pre-small incision-assisted laparoscopic radical gastrectomy with D_2 lymph node dissection has been proved to be a time-saving procedure with small amount of blood loss.The surgical procedure is very simple.It has great clinical value and is worthy of popularizing.
引文
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[8]中国医师协会内镜医师分会腹腔镜外科专业委员会,中国研究型医院学会机器人与腹腔镜外科专业委员会,中国腹腔镜胃肠外科研究组.中国腹腔镜胃癌根治手术质量控制专家共识(2017版)[J].中华消化外科杂志,2017,16(6):539-547.
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[10]季加孚,胡祥,陈凛,等.胃切除术后消化道重建技术专家共识[J].中国实用外科杂志,2014,34(3):205-212.
[11]胃癌手术消化道重建机械吻合专家共识[J].中国实用外科杂志,2015,35(6):584-592.
[12]王家镔,黄昌明,郑朝辉,等.腹腔镜胃癌D2根治术218例疗效评价[J].中华外科杂志,2010,48(7):502-505.
[13]黄昌明,王家镔,郑朝辉,等.腹腔镜辅助胃远端癌淋巴结清扫术近期疗效[J].中华胃肠外科杂志,2009,12(6):584-587.
[14]季加孚,薛侃.外科手术质量体系建立与评价[J].中国实用外科杂志,2016,36(1):1-3.
[15]孙益红,汪学非.胃癌根治手术质量控制标准[J].中国实用外科杂志,2016,36(1):22-24.
[16]王梦桥,徐宇飞,黄河,等.腹腔镜全胃切除后食管空肠Roux-enY重建的临床研究[J].实用医院临床杂志,2014,11(4):138-139.
[17]Lee JH,Han HS,Lee JH.A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer:early results[J].Surg Endosc,2005,19(2):168-173.
[18]肖华,欧阳永忠,汤明,等.围手术期输血与胃癌根治术后并发症的关系[J].中华医学杂志,2014,94(10):751-754.
[2]Goh PM,Khan AZ,So JB,et al.Early experience with laparoscopic radical gastrectomy for advanced gastric cancer[J].Surg Laparosc Endosc Percutan Tech,2001,11(2):83-87.
[3]黄昌明,林建贤,郑朝辉,等.腹腔镜辅助胃癌根治术1380例临床疗效分析[J].中华胃肠外科杂志,2012,15(12):1265-1268.
[4]Park YK,Yoon HM,Kim YW,et al.Laparoscopy-Assisted versus Open D2 Distal Gastrectomy for Advanced Gastric Cancer:Results from a Randomized Phase II Multicenter Clinical Trial(COACT1001)[J].Ann Surg,2017.
[5]Shim JH,Park CH,Song KY.Long-term comparison of laparoscopyassisted distal gastrectomy and open distal gastrectomy in advanced gastric cancer[J].Surg Endosc,2013,27(7):2650-2651.
[6]Hu Y,Ying M,Huang C,et al.Oncologic outcomes of laparoscopy-assisted gastrectomy for advanced gastric cancer:a large-scale multicenter retrospective cohort study from China[J].Surg Endosc,2014,28(7):2048-2056.
[7]廖仲恺,许荣华,何冬雷.场景理念下腹腔镜胃癌根治术的效果[J].中国老年学杂志,2017,37(8):1944-1945.
[8]中国医师协会内镜医师分会腹腔镜外科专业委员会,中国研究型医院学会机器人与腹腔镜外科专业委员会,中国腹腔镜胃肠外科研究组.中国腹腔镜胃癌根治手术质量控制专家共识(2017版)[J].中华消化外科杂志,2017,16(6):539-547.
[9]Association JGC.Japanese gastric cancer treatment guidelines 2010(ver.3)[J].Gastric Cancer,2011,14(2):113-123.
[10]季加孚,胡祥,陈凛,等.胃切除术后消化道重建技术专家共识[J].中国实用外科杂志,2014,34(3):205-212.
[11]胃癌手术消化道重建机械吻合专家共识[J].中国实用外科杂志,2015,35(6):584-592.
[12]王家镔,黄昌明,郑朝辉,等.腹腔镜胃癌D2根治术218例疗效评价[J].中华外科杂志,2010,48(7):502-505.
[13]黄昌明,王家镔,郑朝辉,等.腹腔镜辅助胃远端癌淋巴结清扫术近期疗效[J].中华胃肠外科杂志,2009,12(6):584-587.
[14]季加孚,薛侃.外科手术质量体系建立与评价[J].中国实用外科杂志,2016,36(1):1-3.
[15]孙益红,汪学非.胃癌根治手术质量控制标准[J].中国实用外科杂志,2016,36(1):22-24.
[16]王梦桥,徐宇飞,黄河,等.腹腔镜全胃切除后食管空肠Roux-enY重建的临床研究[J].实用医院临床杂志,2014,11(4):138-139.
[17]Lee JH,Han HS,Lee JH.A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer:early results[J].Surg Endosc,2005,19(2):168-173.
[18]肖华,欧阳永忠,汤明,等.围手术期输血与胃癌根治术后并发症的关系[J].中华医学杂志,2014,94(10):751-754.