3D腹腔镜胃癌根治术的初步临床效果观察

Preliminary observations on clinical efficacy of three-dimensional laparoscopic radical gastrectomy

目的探讨3D腹腔镜辅助胃癌根治术的安全性、可行性和临床应用价值。方法选择行腹腔镜辅助胃癌根治术的87例胃腺癌患者,按照手术时所采用的设备类型将患者分为3D腹腔镜手术组(n=38)和2D腹腔镜手术组(n=49),所有患者均由单一治疗组收治,比较两组患者的手术方式、手术时间、术中出血量、病理情况、术后并发症、术后排气时间、住院天数等。结果两组患者的手术方式、肿瘤大小、肿瘤部位、清扫淋巴结个数及TNM分期比较,差异均无统计学意义(P﹥0.05);3D腹腔镜手术组的平均手术时间及术中出血量均少于2D腹腔镜手术组,术后排气时间、术后住院时间均较2D腹腔镜手术组短(P﹥0.05);两组患者中均无中转开腹病例;87例患者均获得随访,中位随访时间为7个月,随访期间无手术相关并发症发生,无肿瘤复发,无患者死亡。结论3D腹腔镜胃癌根治术安全可行,可为术者提供清晰的三维立体视觉,操作精细,值得临床推广,但仍需要大规模多中心临床试验来进一步验证其临床效果。

Objective To evaluate the safety, feasibility, and short-term effects of three-dimensional （3D） laparoscop-ic-assisted radical gastrectomy （LARG）. Method 87 cases of gastric adenocarcinoma with elective LARG were included in the study, in which 38 patients who underwent LARG using a high-definition 3D laparoscope and 49 patients who un-derwent LARG using a two-dimensional （2D） laparoscope were stratified as 3D LARG group and 2D LARG group, re-spectively, and the two groups were compared with respect to surgical approach, operative time, blood loss, post-opera-tive complications, pathologic data, post-operative intestinal flatus, and hospital stay. Result There was no significant difference observed between the surgical approach, tumor size, tumor location, number of resected lymph nodes, and TNM stage of the two groups （P〉0.05）;While the 3D LARG group had less average operative time and fewer blood loss, as well as shorter time to postoperative intestinal flatus and hospital stay than 2D LARG group （P〉0.05）;None of these patients had salvage laparotomy;All patients were followed for a median time of 7 months, and no deaths, no tumor recur-rences, or metastases were recorded. Conclusion 3D LARG is safe and feasible, facilitating the operators with precise and stereoscopic vision, which is clinically applicable;However, further large-sample studies, preferably prospective ran-domized control trials, are required to confirm the clinical effect.