全腹腔镜与腹腔镜辅助全胃切除术治疗胃癌临床观察

Clinical observation of total laparoscopic and laparoscopic assisted total gastrectomy for gastric cancer

目的腹腔镜下胃癌根治术已成为目前符合胃癌指征患者临床首选治疗方案,本研究探讨腹腔镜辅助下和全腹腔镜下全胃切除术后食管空肠吻合消化道重建方案对行胃癌根治术患者围手术期临床指标及切口并发症的影响。方法选取江苏省丹阳市第三人民医院和东部战区空军医院2015-01-01-2018-05-31收治的行胃癌根治术患者共124例,其中84例采用腹腔镜辅助下全胃切除术后食管空肠吻合设为对照组,40例采用全腹腔镜下全胃切除术后食管空肠吻合设为观察组;比较两组术中、术后临床指标水平及切口并发症发生率。结果观察组手术出血量为(130.50±46.37)mL,少于对照组的(165.07±54.56)mL,t=3.669,P<0.001。观察组术后首次疼痛视觉模拟评分(visual analog scale,VAS)为(2.87±0.55)分,低于对照组的(6.39±1.08)分,t=5.176,P<0.001;术后首次下床活动时间为(1.55±0.39)d,短于对照组的(2.73±0.65)d,t=4.338,P<0.001;术后首次排气时间为(2.70±0.41)d,短于对照组的(4.07±0.75)d,t=6.259,P<0.001;术后住院时间为(6.92±1.60)d,短于对照组的(9.20±1.99)d,t=4.054,P<0.001。观察组切口并发症发生率为2.50%,低于对照组的19.05%,校正χ2=7.142,P<0.001。结论相较于腹腔镜辅助下全胃切除消化道重建方案,全腹腔镜下全胃切除术后食管空肠吻合消化道重建方案用于行胃癌根治术患者可有效减少术中出血量,缓解术后疼痛,加快术后康复进程,并有助于预防切口并发症发生。

OBJECTIVE Laparoscopic radical resection of gastric cancer has become the first clinical treatment option for patients with gastric cancer that meets the indications.This study explored the effects of laparoscopic-assisted and total laparoscopic total gastrectomy with esophagojejunostomy and digestive tract reconstruction on perioperative clinical indicators and incision complications in patients undergoing radical gastrectomy.METHODS A total of 124 patients undergoing radical gastrectomy were selected from Third People’s Hospital of Danyang City in Jiangsu Province and the Eastern Theater Air Force Hospital from January 1,2015 to May 31,2018.Among them,84 patients underwent laparoscopic-assisted total gastrectomy esophageal-jejunal anastomosis were set as the control group,and 40 cases of esophagealjejunal anastomosis after total laparoscopic total gastrectomy were set as the observation group.The intraoperative and postoperative clinical index levels and incidence of incision complications were compared between the two groups.RESULTS The surgical blood loss of the observation group was(130.50±46.37)ml,which was less than that of the control group(165.07±54.56)ml,t=3.669,P<0.001.The visual analog scale(VAS)for the first postoperative pain in the observation group was 2.87±0.55,which was lower than that of the control group 6.39±1.08,t=5.176,P<0.001.The first time to get out of bed after operation was(1.55±0.39)d,which was shorter than that of the control group(2.73±0.65)d,t=4.338,P<0.001.The first postoperative exhaust time was(2.70±0.41)d,which was shorter than that of the control group(4.07±0.75)d,t=6.259,P<0.001.The postoperative hospital stay was(6.92±1.60)d,which was shorter than that of the control group(9.20±1.99)d,t=4.054,P<0.001.The incidence of incision complication in the observation group was 2.50%,which was lower than that of the control group 19.05%,adjustedχ2=7.142,P<0.001.CONCLUSIONS Compared with laparoscopic-assisted total gastrectomy and digestive tract reconstruction program,total laparoscopic total gastrectomy with esophagojejunostomy and digestive tract reconstruction program for patients undergoing radical gastrectomy can effectively reduce intraoperative bleeding and relieve postoperative pain,to speed up the postoperative recovery process,and help prevent incision complications.