3D与2D腹腔镜胃肠道肿瘤手术的比较研究

Comparative study of 3D and 2D laparoscopic surgery for gastrointestinal tumors

目的评估3D腹腔镜较2D腹腔镜应用于胃肠道肿瘤手术的技术优势。方法回顾性分析2015年1月至2017年1月间于吉林大学中日联谊医院胃肠结直肠肛门外科接受3D或2D腹腔镜胃癌根治术（全胃切除术，93例；3D组48例，2D组45例）、直肠癌根治术（均清扫侧方淋巴结，45例；3D组27例，2D组18例）及右半结肠癌根治术（76例；3D组37例，2D组39例）患者的临床资料。患者纳入研究的标准为18~ 80岁经病理确诊为进展期胃和结直肠癌，排除术前发现远处转移者、合并严重心、肺疾病而无法承受腹腔镜手术者、联合脏器切除以及被迫中转开腹者。手术方式的选择均由患者与术者共同商议而定，手术均由同一手术组完成。分析比较3D组与2D组患者的总手术时间、复杂操作时间（深部淋巴结清扫时间、腔镜下肠吻合时间）、淋巴结清扫数目、错抓次数（同一部位需要两次以上的定位才能正确地抓取）及术中出血量。结果3D组与2D组患者一般资料比较，差异均无统计学意义。所有入组患者均顺利完成腹腔镜根治术，无中转开腹。胃癌患者中，3D组较2D组总手术时间缩短[（185 ± 25）min比（190 ± 27）min，P 〈 0.05]，No. 10和11d淋巴结清扫时间短缩[（40 ± 8）min比（55 ± 12）min，P 〈 0.05]，No.7、8、9和12组淋巴结清扫时间缩短[（30 ± 6）min比（41 ± 9）min，P 〈 0.05]，错抓次数减少[（5 ± 2）次比（11 ± 2）次，P 〈 0.05]；直肠癌患者中，3D组较2D侧方淋巴结清扫时间缩短[（27 ± 6）min比（35 ± 9）min，P 〈 0.05]，腔镜下肠吻合时间缩短[（45 ± 7）min比（58 ± 11）min，P 〈 0.05]，操作过程中抓错次数减少[（4 ± 2）次比（13 ± 2）次，P 〈 0.05]；右半结肠癌患者中，3D组较2D组腔镜下肠吻合时间缩短[（38 ± 7）min比（44 ± 5）min，P 〈 0.05]，操作过程中抓错次数减少[（5 ± 1）次比（13 ± 3）次，P 〈 0.05]；而在淋巴结清扫数量和术中出血量方面，两组患者差异均无统计学意义（均P 〉 0.05）。结论3D腹腔镜技术对于胃肠道肿瘤手术，较2D腹腔镜技术具有显著优势，能改善手术操作中的空间定位和深度感，降低精细操作的难度，缩短手术时间。

ObjectiveTo evaluate the technical advantages of 3D laparoscopic and 2D laparoscopic surgery for gastrointestinal tumors.MethodsClinical data of gastrointestinal cancer patients undergoing 3D laparoscopic or 2D laparoscopic surgery from January 2015 to January 2017 in our department were retrospectively analyzed These patients included 93 gastric cancer cases undergoing laparoscopic radical resection （total gastrectomy, 48 cases in 3D group, 45 cases in 2D group） , 45 rectal cancer cases undergoing radical resection combined with lateral lymph node dissection （27 cases in 3D group, 18 cases in 2D group） and 76 right colon cancer cases undergoing radical resection （37 cases in 3D group, 39 cases in 2D group） . The enrolled criteria of cases were 18-80 years old and diagnosed as advanced gastric or colorectal cancer by pathological examination. Patients with preoperative distant metastasis, severe heart or lung diseases who were not suitable for laparoscopic surgery, combined organ resection and conversion to open surgery were excluded. The choice of surgical procedure was determined by the discussion between patients and surgeon. Operations were performed by the same surgical team. Total operation time, complex operation time （deep lymph node dissection time, endoscopic intestinal anastomosis time） , number of harvested lymph node, number of times in wrong grasp （accurate grasp for the same site needs to position for two times or more） and intraoperative bleeding were compared between 3D group and 2D group. ResultsThere were no significant differences in baseline data between 3D group and 2D group. All the patients completed laparoscopic radical operation successfully without conversion to open surgery. In patients with gastric cancer, compared with 2D group, the total operation time was shorter[ （185± 25） min vs. （190 ± 27） min, P〈0.05]; dissection time of No.10 and 11d lymph node [ （40 ± 8） min vs. （55 ± 12） min, P〈0.05], and No.7, 8, 9 and 12 lymph node [ （30 ± 6） min vs. （41 ± 9） min, P〈0.05] was shorter; the number of times in wrong grasp （5 ± 2 vs. 11 ± 2, P〈0.05） was less in 3D group. In patients with rectal cancer, compared with group 2D, 3D group had shorter time of lateral lymph node dissection [ （27 ± 6） min vs. （35 ± 9） min, P〈0.05] and laparoscopic anastomosis [ （45 ± 7） min vs. （58 ± 11） min, P〈0.05]; less number of times in wrong grasp （4 ± 2 vs. 13 ± 2, P〈0.05]. In patients with right colon cancer, 3D group had shorter laparoscopic anastomosis time [ （38 ± 7） min vs. （44 ± 5） min, P〈0.05] and less number of times in wrong grasp （5±1 vs. 13 ± 3, P〈0.05] as compared to 2D group.Conclusion3D laparoscopic surgery for gastrointestinal tumors, compared with 2D laparoscopic technology has significant advantages, which can improve the spatial location and depth of operation, decrease the difficulty of fine operation, and shorten the operation time.