3D腹腔镜手术系统在胃肠肿瘤根治术中的应用

Retrospective analysis： the application of 3D laparoscopy in gastric surgery and colorectal surgery

目的 探讨3D腹腔镜系统在胃肠肿瘤根治术中的应用价值.方法 回顾性分析自2013年10月-2014年10月在上海市微创外科临床医学中心收治的53例通过3D腹腔镜系统进行的腹腔镜胃肠肿瘤根治术患者的临床资料.其中14例行腹腔镜右半结肠癌根治术（其中2例同时行胆囊切除术）,17例行腹腔镜经腹直肠前切除术（其中1例同时行胆囊切除术）,3例行腹腔镜腹会阴联合直肠癌根治术,3例行腹腔镜乙结肠癌根治术（其中1例同时行胆囊切除术）,2例行腹腔镜左半结肠癌根治术,1例行腹腔镜横结肠癌根治术,8例行腹腔镜胃癌根治术（其中1例同时行胆囊切除术）,1例行腹腔镜下胃癌＋乙结肠癌根治术和4例行腹腔镜胃间质瘤切除术.结果 全组53例患者均在3D腹腔镜下成功完成手术,无中转开腹,无术中并发症,无手术相关死亡患者.手术中位时间为180 （70～370） min,术中中位失血为40 （10～300） mL.术后平均排气时间2（1～5）d,手术后平均住院天数8（2～46）d.术后1例直肠前切除术患者出现吻合口瘘;1例腹会阴联合直肠癌根治患者术后出现会阴切口感染;1例远端胃癌根治术患者术后出现十二指肠残端瘘.均以保守治疗方法治愈.结论 3D腹腔镜其手术操作与传统2D腹腔镜相似,能达到与传统腹腔镜手术相当的临床疗效.进一步的临床研究将有助于对其更加全面的评价.

Objective 3D laparoscopic system continued to in recent decade as the technology of 3D visualization becomes more mature nowadays.There were few studies compared （2D） HD laparoscopic system with 3D laparoscopic system in clinical general operation field.We have an early start in general laparoscopic surgery field with 3D system.This study summarized the experiences of 3D laparoscopy operations in the initial stage.Methods In this study,a retrospective analysis was performed among 53 cases of 3D laparoscopic abdominal operations in Shanghai Minimally Invasive Surgery Center （ex：gastric surgery and colorectal surgery） from October 2013 to October 2014 （25 males,28 females）.Among them,there were 14 cases of laparoscopic right hemicolectomies （one with laparoscopic cholecystectomy）,17 cases of laparoscopic radical resection of rectal carcinoma （one with laparoscopic cholecystectomy）,3 cases of abdominopenneal resection of the rectum,3 cases of laparoscopic sigmoidectomies （one with laparoscopic cholecystectomy）,2 cases of laparoscopic left hemicolectomies,1 case of laparoscopic transverse colectopy,8 cases of radical gastrectomies （one with laparoscopic cholecystectomy）,1 case of radical gastrectomy and sigmoidectomy,and 4 cases of gastric stromal tumor＇s resection.Outcome Measures were analyzed by patients＇ information,surgical data,postoperative convalescent conditions and pathological diagnosis.Results All 53 cases underwent surgical treatment with 3D laparoscopy system.There was no conversion to open,intraoperative complications or operation related death.The median operation time was 180min （range 70-370 min）,and the median blood loss was 40 ml （range 10-300 ml）.The median flatus time was 2 days （range 1-5 days）,and the median hospitalization days was 8 days （range 2-46 days）.There were complications in 1 case with anastomotic bleeding in the group of laparoscopic anterior resection of rectum,1 case with wound infection in the group of abdominoperineal resection of the rectum,and 1 case with duodenal stump leakage in the group of LADG ＋ D2 ＋ R-Y.Conclusions Different with others previous study,we concluded that 3D laparoscopic system shares the similar surgical procedures with 2D laparoscopic system,and it could also provide the shorter learning curve for the surgery.