预先小切口辅助腹腔镜远端胃癌根治术临床疗效观察
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摘要
目的探讨预先小切口辅助腹腔镜远端胃癌根治术临床疗效。方法回顾性分析2014年7月～2017年4月我院收治的156例远端胃癌患者的临床资料,将50例行预先小切口辅助腹腔镜手术患者设为预先小切口组,48例行全腹腔镜手术患者设为全腹腔镜组,58例行开腹手术患者设为开腹组。观察3组患者性别、年龄、BMI、肿瘤直径、术前麻醉ASA分级、吻合方式、TNM分期、术前合并症,手术切口长度、手术时间、清扫No.4d、5、6、7、8、12组淋巴结时间及出血量、术中出血量、术中淋巴结清扫数量、首次排气时间、术后下床活动时间、术后24、72h疼痛评分,术后使用止痛药物次数、术后住院时间、术后并发症,比较3组患者临床疗效。结果预先小切口组切口长度显著短于开腹组,但较全腹腔镜组长,差异有统计学意义(P<0.05);预先小切口组手术时间、清扫No.4d、5、6、7、8、12组淋巴结时间及出血量均小于全腹腔镜组,差异有统计学意义(P<0.05);与开腹组相比差异无统计学意义(P>0.05);预先小切口组术中出血量、首次排气时间、术后下床活动时间及术后24、72h疼痛评分、术后使用止痛药物次数、术后住院时间均优于开腹组,差异有统计学意义(P<0.05),与全腹腔镜组比较,差异无统计学意义(P>0.05)。结论预先小切口辅助腹腔镜远端胃癌根治术安全、省时、出血量少,值得临床推广应用。
Objective To explore the clinical effect of pre-small incision in laparoscopy-assisted radical gastrectomy for distal gastric cancer.Methods The clinical data of 156 patients with distal gastric cancer were collected from Sichuan Province People's Hospital from July 2014 to April 2017.Among them,50 patients with pre-small incision laparoscopicassisted surgery were enrolled in pre-small incision group,48 patients with totally laparoscopic surgery in total laparoscopy group and 58 patients with open abdominal in open surgery group.The age,BMI,tumor diameter,gender,preoperative anesthesia ASA classification,anastomosis,TNM staging,preoperative complications,surgical incision length,operation time,cleaning No.4 d,5,6,7,8,12 groups of lymph node time and blood loss,intraoperative blood loss,number of intraoperative lymph node dissections,first discharge time,postoperative bedtime,postoperative 24-hour and 72-hour pain scores,number of postoperative pain medications,postoperative Hospitalization time,postoperative complications,and clinical efficacy of the three groups were analyzed.Results The incision length in the pre-small incision group was significantly shorter than that in the open abdominal group,but longer than that in total laparoscopy group(P<0.05).In the pre-small incision group,the operation time,the time and the amount of blood loss for lymph node dissection of No.4 d,5,6,7,8,12 were less than those in the total laparoscopy group(P<0.05),but no significant difference compared with the open surgry group,(P>0.05).There were statistically significant difference in bleeding amount during surgery,anus exhaust time,the postoperative ambulation time,the postoperative 24 h、72 hpain score,the frequency of using pain medication and postoperative hospital stay between the pre-small incision group and open surgery group(P<0.05),but no significant difference compared with the total laparoscopy group(P>0.05).Conclusion The pre-small incision-assisted laparoscopic radical gastrectomy has been proved to be a safe and time-saving procedure with small amount of blood loss and short learning curve and is worth to be popularized.
Objective To explore the clinical effect of pre-small incision in laparoscopy-assisted radical gastrectomy for distal gastric cancer.Methods The clinical data of 156 patients with distal gastric cancer were collected from Sichuan Province People's Hospital from July 2014 to April 2017.Among them,50 patients with pre-small incision laparoscopicassisted surgery were enrolled in pre-small incision group,48 patients with totally laparoscopic surgery in total laparoscopy group and 58 patients with open abdominal in open surgery group.The age,BMI,tumor diameter,gender,preoperative anesthesia ASA classification,anastomosis,TNM staging,preoperative complications,surgical incision length,operation time,cleaning No.4 d,5,6,7,8,12 groups of lymph node time and blood loss,intraoperative blood loss,number of intraoperative lymph node dissections,first discharge time,postoperative bedtime,postoperative 24-hour and 72-hour pain scores,number of postoperative pain medications,postoperative Hospitalization time,postoperative complications,and clinical efficacy of the three groups were analyzed.Results The incision length in the pre-small incision group was significantly shorter than that in the open abdominal group,but longer than that in total laparoscopy group(P<0.05).In the pre-small incision group,the operation time,the time and the amount of blood loss for lymph node dissection of No.4 d,5,6,7,8,12 were less than those in the total laparoscopy group(P<0.05),but no significant difference compared with the open surgry group,(P>0.05).There were statistically significant difference in bleeding amount during surgery,anus exhaust time,the postoperative ambulation time,the postoperative 24 h、72 hpain score,the frequency of using pain medication and postoperative hospital stay between the pre-small incision group and open surgery group(P<0.05),but no significant difference compared with the total laparoscopy group(P>0.05).Conclusion The pre-small incision-assisted laparoscopic radical gastrectomy has been proved to be a safe and time-saving procedure with small amount of blood loss and short learning curve and is worth to be popularized.
引文
[1]左婷婷,郑荣寿,曾红梅,等.中国胃癌流行病学现状[J].中国肿瘤临床,2017,(1):52-58.
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[12] Rauh K H,Andersen R S,Rosenberg J.Visual analogue scalefor measuring post-operative pain[J].Ugeskr Laeger,2013,175(24):1712-1716.
[13] Kitano S,Iso Y,Moriyama M,et al.Laparoscopy-assisted Bill-roth I gastrectomy[J].Surg Laparosc Endosc,1994,4(2):146-148.
[14] Goh P M,Khan A Z,So J B,et al.Early experience with lapa-roscopic radical gastrectomy for advanced gastric cancer[J].Surg Laparosc Endosc Percutan Tech,2001,11(2):83-87.
[15] Zhang X,Tanigawa N.Learning curve of laparoscopic surgeryfor gastric cancer,a laparoscopic distal gastrectomy-based analy-sis[J].Surg Endosc,2009,23(6):1259-1264.
[16] Zhou D,Quan Z,Wang J,et al.Laparoscopic-assisted versusopen distal gastrectomy with D2lymph node resection for ad-vanced gastric cancer:effect of learning curve on short-term out-comes.a meta-analysis[J].J Laparoendosc Adv Surg Tech A,2014,24(3):139-150.
[17] Jung D H,Son S Y,Park Y S,et al.The learning curve associ-ated with laparoscopic total gastrectomy[J].Gastric Cancer,2016,19(1):264-272.
[18] MacLellan S J,MacKay H J,Ringash J,et al.Laparoscopicgastrectomy for patients with advanced gastric cancer producesoncologic outcomes similar to those for open resection[J].SurgEndosc,2012,26(7):1813-1821.
[19] Son S Y,Kim H H.Minimally invasive surgery in gastric cancer[J].World J Gastroenterol,2014,20(39):14132-14141.
[20] Lee S I,Choi Y S,Park D J,et al.Comparative study of lapa-roscopy-assisted distal gastrectomy and open distal gastrectomy[J].J Am Coll Surg,2006,202(6):874-880.
[2]季加孚.我国胃癌防治研究三十年回顾[J].中国肿瘤临床,2013,40(22):1345-1351.
[3] Venkat R,Edil B H,Schulick R D,et al.Laparoscopic distalpancreatectomy is associated with significantly less overall mor-bidity compared to the open technique:a systematic review andmeta-analysis[J].Ann Surg,2012,255(6):1048-1059.
[4] Zhou M W,Gu X D,Xiang J B,et al.Clinical safety and out-comes of laparoscopic surgery versus open surgery for palliativeresection of primary tumors in patients with stage IV colorectalcancer:a meta-analysis[J].Surg Endosc,2016,30(5):1902-1910.
[5] Chen K,Zhou Y C,Mou Y P,et al.Systematic review and me-ta-analysis of safety and efficacy of laparoscopic resection forgastrointestinal stromal tumors of the stomach[J].Surg En-dosc,2015,29(2):355-367.
[6]黄昌明,林建贤.全腹腔镜胃癌根治术规范化实施策略与技术难点[J].中国实用外科杂志,2016,(9):925-928.
[7] Association J G C.Japanese gastric cancer treatment guidelines2010(ver.3)[J].Gastric Cancer,2011,14(2):113-123.
[8]梁寒.胃癌远端胃切除术后消化道重建手术方式的选择及临床评价[J].中华消化外科杂志,2016,15(3):216-220.
[9]张祚聪,崔明福,孙立波.远端胃癌手术后消化道重建方法的研究进展[J].中国普外基础与临床杂志,2017,(6):775-778.
[10]戴冬秋,张春东.经腹远端胃癌根治术规范化实施及评价[J].中国实用外科杂志,2014,(7):608-611.
[11]黄昌明,林建贤.腹腔镜胃癌根治术淋巴结清扫手术入路的合理选择[J].中国肿瘤临床,2017,(4):151-154.
[12] Rauh K H,Andersen R S,Rosenberg J.Visual analogue scalefor measuring post-operative pain[J].Ugeskr Laeger,2013,175(24):1712-1716.
[13] Kitano S,Iso Y,Moriyama M,et al.Laparoscopy-assisted Bill-roth I gastrectomy[J].Surg Laparosc Endosc,1994,4(2):146-148.
[14] Goh P M,Khan A Z,So J B,et al.Early experience with lapa-roscopic radical gastrectomy for advanced gastric cancer[J].Surg Laparosc Endosc Percutan Tech,2001,11(2):83-87.
[15] Zhang X,Tanigawa N.Learning curve of laparoscopic surgeryfor gastric cancer,a laparoscopic distal gastrectomy-based analy-sis[J].Surg Endosc,2009,23(6):1259-1264.
[16] Zhou D,Quan Z,Wang J,et al.Laparoscopic-assisted versusopen distal gastrectomy with D2lymph node resection for ad-vanced gastric cancer:effect of learning curve on short-term out-comes.a meta-analysis[J].J Laparoendosc Adv Surg Tech A,2014,24(3):139-150.
[17] Jung D H,Son S Y,Park Y S,et al.The learning curve associ-ated with laparoscopic total gastrectomy[J].Gastric Cancer,2016,19(1):264-272.
[18] MacLellan S J,MacKay H J,Ringash J,et al.Laparoscopicgastrectomy for patients with advanced gastric cancer producesoncologic outcomes similar to those for open resection[J].SurgEndosc,2012,26(7):1813-1821.
[19] Son S Y,Kim H H.Minimally invasive surgery in gastric cancer[J].World J Gastroenterol,2014,20(39):14132-14141.
[20] Lee S I,Choi Y S,Park D J,et al.Comparative study of lapa-roscopy-assisted distal gastrectomy and open distal gastrectomy[J].J Am Coll Surg,2006,202(6):874-880.