完全腹腔镜与腹腔镜辅助胃癌根治术近期临床疗效的对比研究

Comparative Study of Short-Term Outcomes Between Total Laparoscopic Gastrectomy and Laparoscopy-Assisted Gastrectomy for Gastric Cancer

目的比较完全腹腔镜胃癌根治术与传统腹腔镜辅助胃癌根治术的临床疗效,探讨全腹腔镜下吻合技术在腹腔镜胃癌根治术中的安全性及可行性。方法回顾性分析2013年1月至2014年3月期间我科64例行完全腹腔镜胃癌根治术(全腔镜组)和70例行传统腹腔镜辅助胃癌根治术(腔镜辅助组)患者的临床资料。结果134例手术均获成功,无一例中转开腹。与腔镜辅助组相比,全腔镜组的吻合时间〔(73.8±10.3)min比(72.7±8.9)min,t=0.693,P=0.489〕和清扫淋巴结数〔(32.4±9.7)枚比(33.6±9.6)枚,t=-0.700,P=0.485〕差异均无统计学意义,但术中出血量〔(275.0±66.3)m L比(364.3±75.7)m L,t=-7.419,P=0.000〕明显减少,切口长度〔(3.0±0.8)cm比(7.3±1.7)cm,t=-19.354,P=0.000〕明显减小、进食流质时间〔(4.9±0.8)d比(6.0±0.7)d,t=-8.750,P=0.000〕、肛门排气时间〔(2.8±0.8)d比(3.9±0.8)d,t=-8.388,P=0.000〕、下床活动时间〔(1.3±0.5)d比(3.4±1.2)d,t=-14.118,P=0.000〕、住院时间〔(9.8±1.2)d比(13.0±1.5)d,t=-17.471,P=0.000〕明显缩短,且术后患者的疼痛评分〔术后第1 d:(3.4±0.8)分比(6.2±1.3)分,t=-15.509,P=0.000;术后第3 d:〔(1.7±0.6)分比(4.0±0.8)分,t=-18.799,P=0.000〕明显降低和需要的止痛剂剂量〔(1.7±0.7)支比(4.0±2.1)支,t=-8.912,P=0.000〕明显减少。腔镜辅助组出现吻合口漏1例,出现吻合口狭窄3例,吻合口相关并发症发生率为5.7%(4/70)。全腔镜组均未出现吻合口漏、吻合口狭窄或吻合口出血等吻合口相关并发症。结论完全腹腔镜下吻合技术在腹腔镜胃癌根治术中安全、可行,与小切口辅助吻合相比具有创伤小、出血少、恢复快、住院时间短、疼痛感轻等优势,近期效果显著。

Objective To compare clinical efficacy of totally laparoscopic gastrectomy（TLG） and conventional laparoscopy-assisted gastrectomy（LAG） and to explore safety and feasibility of total laparoscopic anastomosis in laparoscopic gastrectomy. Method The clinical data of 64 patients who received TLG and another 70 patients who received conventional LAG in our department from January 2013 to March 2014 were retrospectively analyzed. Results All procedures were completed successfully. There were no significant differences in the time of anastomosis 〔（73.8±10.3） min versus（72.7±8.9） min, t=0.693, P=0.489〕 and the number of dissected lymph nodes（32.4±9.7 versus 33.6±9.6, t=-0.700, P=0.485） between the patients underwent TLG and the patients underwent LAG. However there were obvious differences in the blood loss 〔（275.0±66.3） m L versus（364.3±75.7） m L, t=-7.419, P=0.000〕, the incision length 〔（3.0±0.8） cm versus（7.3±1.7） cm, t=-19.354, P=0.000〕, the time to fluid diet 〔（4.9±0.8） d versus（6.0±0.7） d, t=-8.750, P=0.000〕 and the time to flatus〔（2.8±0.8） d versus（3.9±0.8） d, t=-8.388, P=0.000〕, the off-bed time 〔（1.3±0.5） d versus（3.4±1.2） d, t=-14.118, P=0.000〕,and the hospital stay 〔（9.8±1.2） d versus（13.0±1.5） d, t=-17.471, P=0.000〕 between the patients underwent TLG and the patients underwent LAG. Meanwhile it was found that the postoperative pain score 〔On day 1 postoperatively：（3.4±0.8） points versus（6.2±1.3） points, t=-15.509, P=0.000; on day 3 postoperatively：（1.7±0.6） points versus（4.0±0.8） points, t=-18.799, P=0.000〕 and the dosage of pain killers（1.7±0.7 versus 4.0±2.1, t=-8.912, P=0.000） in the patients underwent TLG were significantly lower than those in the patients underwent LAG. One patient developed anastomotic leakage and 3 patients developed anastomotic stenosis in the patients underwent LAG, the complication rate related to the anastomosis was 5.7%（4/70）. While there were no complications related to the anastomosis in including anastomotic leakage, stenosis, and bleeding in the patients underwent TLG. Conclusions Total laparoscopic anastomosis is safe and feasible in laparoscopic gastrectomy for gastric cancer. Compared with small incision-assisted anastomosis, totally laparoscopic anastomosis is associated with minimal trauma, less blood, quicker postoperative recovery, shorter time, slighter pain and satisfactory short-term efficacy.