3D腹腔镜辅助保留迷走神经远端根治术治疗胃癌的疗效及近期生活质量评价
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摘要
目的探究3D腹腔镜辅助保留迷走神经远端根治术对胃癌治疗的疗效和近期生活质量的影响。方法回顾性分析2014年10月至2016年10月胃癌患者120例资料,根据手术方式不同分为三组,分别为3D保留组,3D常规组以及2D保留组各40例。采用SPSS 21.0软件进行统计学分析,围术期相关指标、生活质量评分、胃排空功能和胆囊收缩功能指标采用(■±s)描述,两组间比较t检验,三组间经方差齐性检验分析;计数资料组间比较采用χ~2检验。P<0.05差异有统计学意义。结果三组患者在手术时间、平均淋巴结清扫数、术中出血量、术后住院时间以及肛门首次排气时间等方面经比较,差异无统计学意义(P>0.05);3D保留组与2D保留组在胃排空功能和胆囊收缩功能方面相比不具有统计学差异(P>0.05),但显著优于3D常规组(P<0.05);3D保留组患者术后3个月,6个月生活质量评分明显高于其他两组患者(P<0.05),而在12个月质量评分方面3D保留组与2D保留组差异无统计学意义(P>0.05),但仍显著高于3D常规组(P<0.05)。结论 3D腹腔镜辅助保留迷走神经远端根治术对胃癌治疗的疗效和近期生活质量的改善,具有较高的价值,值得进一步推广应用。
Objective To investigate the efficacy and recent quality of life of 3D laparoscopic assisted vagal nerve-preserving distal radical surgery on patients with gastric cancer.Methods Aretrospective analysis of 120 patients with distal gastric cancer treated in our hospital from October 2014 to October 2016 was divided into three groups based on different surgical methods:3D retention group,3Droutine group,and 2D retention group,each 40 cases.SPSS 21.0 software was used to statistically analyze the effect of the three groups of surgical procedures on the patient's curative effect and recent quality of life.The perioperative indicators,gastric emptying function,gallbladder systolic function,and quality of life scores were described in the form of(■±s),and compared with t-tests between the two groups,and F-tests were performed among the three groups.Relevant count data in clinical basic data were analyzed usingχ~2test.P<0.05 meant a statistical difference.Results The three groups of patients had no statistical difference in the operation time,intraoperative blood loss,average number of lymph node dissections,first anus exhaust time,and postoperative hospital stay(P>0.05);there was no statistical difference in the gastric emptying function and gallbladder contraction function between the 3D retention group and the 2Dretention group(P>0.05),but those was significantly better than 3D conventional group(P<0.05);3Dretention group patients'quality of life scores at 3 months and 6 months after operation were significantly higher than those in the other two groups(P<0.05).There was no significant difference between the 3Dretention group and the 2D retention group in the 12-month quality score(P>0.05),but it was still significantly higher than that of the 3D routine group(P<0.05).Conclusion 3D laparoscopically assisted vagal nerve-preserving distal radical surgery for the treatment of gastric cancer has improvement of recent quality of life,and it is worth further promotion and application.
Objective To investigate the efficacy and recent quality of life of 3D laparoscopic assisted vagal nerve-preserving distal radical surgery on patients with gastric cancer.Methods Aretrospective analysis of 120 patients with distal gastric cancer treated in our hospital from October 2014 to October 2016 was divided into three groups based on different surgical methods:3D retention group,3Droutine group,and 2D retention group,each 40 cases.SPSS 21.0 software was used to statistically analyze the effect of the three groups of surgical procedures on the patient's curative effect and recent quality of life.The perioperative indicators,gastric emptying function,gallbladder systolic function,and quality of life scores were described in the form of(■±s),and compared with t-tests between the two groups,and F-tests were performed among the three groups.Relevant count data in clinical basic data were analyzed usingχ~2test.P<0.05 meant a statistical difference.Results The three groups of patients had no statistical difference in the operation time,intraoperative blood loss,average number of lymph node dissections,first anus exhaust time,and postoperative hospital stay(P>0.05);there was no statistical difference in the gastric emptying function and gallbladder contraction function between the 3D retention group and the 2Dretention group(P>0.05),but those was significantly better than 3D conventional group(P<0.05);3Dretention group patients'quality of life scores at 3 months and 6 months after operation were significantly higher than those in the other two groups(P<0.05).There was no significant difference between the 3Dretention group and the 2D retention group in the 12-month quality score(P>0.05),but it was still significantly higher than that of the 3D routine group(P<0.05).Conclusion 3D laparoscopically assisted vagal nerve-preserving distal radical surgery for the treatment of gastric cancer has improvement of recent quality of life,and it is worth further promotion and application.
引文
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[5] 杜晓辉,胡时栋.腹腔镜胃癌根治术保脾脾门淋巴结清扫术技巧及意义[J/CD].中华普外科手术学杂志(电子版),2018,12(2):95-98.
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[8] Sorensen SM,Savran MM,Konge L,et al.Three-dimensional versus two- dimensional vision in laparoscopy:a systematic review [J].Surg Endosc,2016,30(1):11-23.
[9] 黄冀华,梁伟成,蔡锐文,等.腹腔镜与开腹远端胃癌D2根治术的临床疗效比较[J].中国现代普通外科进展,2016,19(8):658-660.
[10] Hu Y,Huang C,Sun Y,et a1.Morbidity andMortality of Laparoscopic Versus Open D2 Distal Gastrectomy for Advanced Gastric Cancer:A Randomized Controlled Trial[J].J Clin Oncol,2016,34(12):1350-1357.
[11] 王静铭,邢俊杰,刘宏,等.3D腹腔镜与2D腹腔镜辅助远端胃癌D2根治术的应用对比[J/CD].中华普外科手术学杂志(电子版),2018,12(2):115-118.
[12] 廖南生,林峰.保留胃迷走神经远端胃癌根治术疗效及对患者术后营养状况和预后的影响[J].中华全科医学,2016,14(5):866-868.
[13] Haverkamp L,Ruurda JP,Offerhaus GJ,et al.Laparoscopic gastrectomy in Western European patients with advanced gastric cancer [J].Eur J Surg Oncol,2016,42(1):110-115.
[14] Tang FJ,Qi L,Jiang HC,et al.Comparison of the c1inical effectiveness of 3D and 2D imaging systems for laparoscopic radical cysteetomy with pelvic lymph node dissection[J].J Int Med Res,2016,44(3):613-619.
[15] 梅勇,罗青,任江,等.早期远端胃癌行胃部分切除术中保留迷走神经的临床疗效分析[J].实用癌症杂志,2017 ,32 (3) :432-434.
[2] Kim SM,Cho J,Kang D,et al.A Randomized controlled trial of vagus nerve-preserving distal gastrectomy versus conventional distal gastrectomy for postoperative quality of life in early stage gastric cancer patients[J].Ann Surg,2016,263(6):1079-1084.
[3] 胡建昆,赵林勇.腹腔镜胃癌根治术的难点与争议[J/CD].中华普外科手术学杂志(电子版),2018,12(2):91-94.
[4] 黄昌明,林建贤.3D腹腔镜胃癌根治术的优势与技术[J/CD].中华普外科手术学杂志:电子版,2016,10(1):4-6.
[5] 杜晓辉,胡时栋.腹腔镜胃癌根治术保脾脾门淋巴结清扫术技巧及意义[J/CD].中华普外科手术学杂志(电子版),2018,12(2):95-98.
[6] Matsuhashi N,Yamaguchi K,Okumura N,et al.The technical outcomes of delta-shaped anastomosis in laparoscopic distal gastrectomy:a single-center safety and feasibility study[J].Surgical Endoscopy,2017,31(3):1257-1263.
[7] 蔡为明.腹腔镜与开腹胃癌根治术治疗远端进展期胃癌疗效比较[J].现代医药卫生,2016,32(21):3342-3344.
[8] Sorensen SM,Savran MM,Konge L,et al.Three-dimensional versus two- dimensional vision in laparoscopy:a systematic review [J].Surg Endosc,2016,30(1):11-23.
[9] 黄冀华,梁伟成,蔡锐文,等.腹腔镜与开腹远端胃癌D2根治术的临床疗效比较[J].中国现代普通外科进展,2016,19(8):658-660.
[10] Hu Y,Huang C,Sun Y,et a1.Morbidity andMortality of Laparoscopic Versus Open D2 Distal Gastrectomy for Advanced Gastric Cancer:A Randomized Controlled Trial[J].J Clin Oncol,2016,34(12):1350-1357.
[11] 王静铭,邢俊杰,刘宏,等.3D腹腔镜与2D腹腔镜辅助远端胃癌D2根治术的应用对比[J/CD].中华普外科手术学杂志(电子版),2018,12(2):115-118.
[12] 廖南生,林峰.保留胃迷走神经远端胃癌根治术疗效及对患者术后营养状况和预后的影响[J].中华全科医学,2016,14(5):866-868.
[13] Haverkamp L,Ruurda JP,Offerhaus GJ,et al.Laparoscopic gastrectomy in Western European patients with advanced gastric cancer [J].Eur J Surg Oncol,2016,42(1):110-115.
[14] Tang FJ,Qi L,Jiang HC,et al.Comparison of the c1inical effectiveness of 3D and 2D imaging systems for laparoscopic radical cysteetomy with pelvic lymph node dissection[J].J Int Med Res,2016,44(3):613-619.
[15] 梅勇,罗青,任江,等.早期远端胃癌行胃部分切除术中保留迷走神经的临床疗效分析[J].实用癌症杂志,2017 ,32 (3) :432-434.