手助腹腔镜胃癌D2手术的临床疗效分析

Clinical Curative Effect Analysis of Hand-assisted Laparoscopic D2 Gastric Cancer Surgery

目的探讨手助腹腔镜技术在胃癌D2手术中的应用价值。方法回顾性分析2013年12月～2015年6月我院120例手助腹腔镜手术（hand—assistedlaparoseopiesurgery，HALS）与130例腹腔镜辅助手术（1aparoscopieassistedsurgery，LAS）治疗胃癌的临床资料，观察指标为手术时间、手术切口长度、肿瘤大小、淋巴结清扫数目、术后AJCC／UICC分期、术后胃肠道恢复时间、术后发热例数、术后止痛剂使用例数、术后鼻饲肠内营养的时间、术后进流质食时间、术后并发症、术后住院时间。结果2组均完成根治性胃切除和胃周淋巴结的彻底清扫，HALS组无一例中转开腹，LAS组有20例中转开腹。HALS组手术时间（228，2±30．8）min，明显短于LAS组手术时间（256．0±46．7）min（t=-5．371，P=0．000）；HALS组手术切口长度（5．2±0．4）cm，与LAS组（5．1±0．5）enl无统计学差异（t=1．681，P=0．094）；HALS组淋巴结清扫数目（16．9±5．9）枚，与IJAs组（16．2±6．4）枚无统计学差异（t=0．863，P=0．389）；HAl．s组术后胃肠道恢复时间（4．3±1．1）d，与IJAs组（4．4±1．9）d无统计学差异（t=-0．493，P=0．622）；HALS组术后发热例数64例，与LAS组57例无统计学差异（X2=0．053，P=0．818）；HAI．S组术后82例使用止痛剂与LAS组79例无统计学羞异（X2=0．332，P=0．565）；HALS组术后鼻饲肠内营养的时间（37±0．8）d，与LAS组（3．6±0，9）d无统计学差异（t=0．892，P=0．373）；HALS组术后进食流质时间（6．0±1．4）d与LAS组（6．2±1．4）d，无统计学差异（t=-1．082，P=0．280）；HALS组术后住院时间（9．8±1．6）d，与LAS组（10．0±1．4）d无统计学差异（t=-1．005，P=0．316）；HALS组术后肠梗阻2例、肺部感染2例，LAS组术后肠梗阻2例、肺部感染2例，2组比较均尤统计学差异（X2=0．000，P=1．000）。2组随访1～19个月，平均9个月，HALS组1例术后6个月死于肝转移，LAS组2例分别于术后10、13个月死于腹腔内多发转移，其余患者在随访期内恢复尚可，无严重并发症发生。结论手助腹腔镜胃癌D2根治术是安全可行的，手术时间明显缩短，作为一种可选择的微创手术方式，值得在临床推广。

Objective To evaluate the clinical value of hand-assisted laparoscopic technology in D2 radical gastrectomy for gastric carcinoma. Methods Clinical data of 120 cases of hand-assisted laparoscopic surgery （HALS group） and 130 eases of laparoscopie assisted surgery （LAS group） for gastric cancer from December 2013 to June 2015 were retrospectively analyzed. The operation time, incision length, tumor size, number of lymph node dissected, AJCC/U1CC staging after operation, postoperative recovery time of gastrointestinal tract, postoperative fever cases, postoperative analgesic use, postoperative nasogastrie enteral nutrition time, postoperative liquid diet time, postoperative complications, postoperative hospital stay. Results Radical resection with lymph node dissection was accomplished in both groups. Conversion to open surgery was required in no case in the HALS group and in 20 cases in the LAS group. The operating time in the HALS group （228.2±30.8 min） was obviously shorter than that in the LAS group （256.0±46.7 min, t = -5. 371, P = 0. 000）. No statistical differences were found between the HALS group and the I,AS group in incision length [（5.2 ±0.4）cm vs. （5.1 ±0.5） cm, t=1.681, P=0.094], number of lymph node dissected [（16.9±5.9） vs. （16.2±6.4）, t=0.863, P=0.389], postoperative recovery time of gastrointestinal tract [（4.3±1.1） d vs. （4.4±1.9） d, t,= -0.493, P=0.622], rate of postoperative fever （64 cases vs. 37 cases,x2 =0.053, P=0.818）, postoperative almlgesic use （82 cases vs. 79 cases, X2 = 0. 332, P = 0. 565 ）, postoperative nasogastrie enteral nutrition time [ （ 3.7± 0.8 ） d vs. （ 3.6 ± 0.9） d, t =-0.892, P=0.373, liquid diet time [（6.0 ±1.4） d vs. （6.2 ±1.4） d, t = -1.082, P=0.280], postoperative hospital stay [ （9.8± 1.6） d vs. （10.0± 1.4） d, t = - 1. 005, P =0. 316] , and postoperative intestinal obstruction and lung infection （2 eases and2 cases vs. 2 eases and 2 eases,x2 =0.000, P=I.000）. Both groups were followed for 1 -19 months （mean, 9 months）. In the HALS group one died of liver metastasis at 6 months after operation, while in the LAS group 2 patients died of multiple metastasis in the abdominal cavity at 10 and 13 months after operation. The remaining patients recovered smoothly in the follow-up period, and no serious complications occurred. Conclusion Hand-assisted laparoscopie D2 gastric cancer radical prostatectomy is safe and feasible, with little trauma, quick recovery, and obviously shortened operation time, which can be used as an alternative of minimally invasive surgery and is worthy of clinical promotion.