腹腔镜与开腹胃癌根治术后早期并发症状性胸腔积液的回顾性研究

A retrospective study on postoperative symptomatic pleural effusion following laparoscopy surgery vs. open surgery in the treatment of gastric cancer

目的比较腹腔镜与开腹胃癌根治术后早期并发症状性胸腔积液的差异性。方法回顾性分析2014年1月至2016年10月在华中科技大学同济医学院附属协和医院胃肠外科实施胃癌根治术的678例病人的临床资料。结果 678例胃癌根治术中66例术后出现了症状性胸腔积液,发生率为9.7%。腹腔镜组327例,术后胸腔积液为11例,发生率为3.4%;开腹组351例,术后胸腔积液为55例,发生率为15.7%,差异有统计学意义(χ2=29.17,P<0.05)。腹腔镜组中远端胃、近端胃、全胃、联合脏器切除分别为189例、38例、69例、31例,术后胸腔积液的例数分别为2例、3例、4例、2例,发生率分别为1.1%、7.9%、5.8%、6.5%。近端胃、全胃与联合脏器切除术后并发胸腔积液发生率之间比较,差异无统计学意义(P>0.05)。但三者与远端胃术后并发胸腔积液发生率之间比较,差异有统计学意义(P<0.05)。开腹组中远端胃、近端胃、全胃、联合脏器切除分别为122例、78例、114例、37例,术后胸腔积液的例数分别为8例、18例、19例、10例,发生率分别为6.6%、23.1%、16.7%、27.0%。近端胃、全胃与联合脏器切除术后并发胸腔积液发生率之间比较,差异无统计学意义(P>0.05)。但三者与远端胃术后并发胸腔积液发生率之间比较,差异有统计学意义(P<0.05)。分别对腹腔镜组与开腹组间远端胃、近端胃、全胃和联合脏器切除术后胸腔积液的发生率进行比较,差异均有统计学意义(P<0.05)。结论腹腔镜手术可能会减少胃癌根治术后早期症状性胸腔积液的产生。

Objective To compare the differences in postoperative symptomatic pleural effusion between laparoscopy surgery and open surgery in the treatment of gastric cancer. Methods The clini- cal data of 678 patients undergoing gastrectomy in Union Hospital of Tongji Medical College, Hua- zhong University of Science and Technology between January 2014 and October 2016 were retrospec- tively analyzed. Results There were 66 cases of postoperative symptomatic pleural effusion in 678 pa- tients with gastric cancer with the rate being 9. 7 %. There were 11 eases of postoperative symptomatic pleural effusion in 327 cases of laparoseopy surgery group with the rate being 3. 4%, and 55 cases of postoperative symptomatic pleural effusion in 351 eases of open surgery group with the rate being 15. 7% （X^2= 29. 17,P〈0. 05）. In laparoscopy surgery group, of 189 eases undergoing distal gastrecto- my,2（1.1%） cases had postoperative symptomatic pleural effusion; of 38 eases undergoing proximal gastreetomy,3（7. 9%） cases had postoperative symptomatic pleural effusion; of 69 eases undergoing total gastrectomy,4（5.8%） cases had postoperative symptomatic pleural effusion; of 31 cases under- going multi-visceral resection,2（6. 5 %） cases had postoperative symptomatic pleural effusion. No sta- tistical differences were found among proximal gastrectomy, total gastrectomy and multi-visceral resec-tion in the rate of postoperative symptomatic pleural effusion （P〉0. 05）. There were statistically sig- nificant differences between proximal gastrectomy, total gastrectomy and multi-visceral resection groups with distal gastrectomy （P〈0. 05）. In open surgery group, of 122 cases undergoing distal gas- trectomy, 8（6. 6%） cases suffered from postoperative symptomatic pleural effusion; of 78 cases under- going proximal gastrectomy, 18（23. 1%） cases suffered from postoperative symptomatic pleural effu- sion; of 114 cases undergoing total gastrectomy, 19（16. 7%） cases suffered from postoperative symp- tomatic pleural effusion; of 37 cases undergoing muki-visceral resection, 10（27.0%） cases suffered from postoperative symptomatic pleural effusion. No statistically significant differences were found a- mong proximal gastrectomy, total gastrectomy and multi-visceral resection in the rate of postoperative symptomatic pleural effusion （P〉0. 05）. There were statistically significant differences between proxi- mal gastrectomy, total gastrectomy and multi-visceral resection groups with distal gastrectomy group （P〈0. 05）. In the groups of distal gastrectomy, proximal gastrectomy, total gastrectomy and multi-vis- ceral resection, there were statistically significant differences between laparoscopy surgery group and open surgery group in the rate of postoperative symptomatic pleural effusion （P〈0. 05）. Conclusions The laparoscopy surgery may reduce the rate of postoperative symptomatic pleural effusion as com- pared with the traditional open surgery.