腹壁小切口辅助腹腔镜切除胃底贲门部肿瘤的临床疗效

Clinical effect of laparoscopic resection with a subsidiary mini-incision in patients with gastric fundus-cardiac tumors

目的探讨腹壁小切口辅助腹腔镜切除胃底贲门部肿瘤的临床应用价值。方法回顾性分析2014年6月至2017年6月收治的189例胃底贲门部肿瘤患者的临床资料,其中腹壁小切口辅助腹腔镜组(小切口组)43例,全腔镜组37例,电子纤维内镜组(内镜组)58例,传统开腹组51例,比较各组的一般资料(性别、年龄、肿瘤大小及部位、胃病史及术前上消化道症状)、术中和术后预后指标(手术时间、术中出血量、术后疼痛评分、术后禁饮及排气时间、术后并发症、术后住院时间、非计划内再手术或再入院率)。统计学检验水准取α=0.05,采用R×C表χ2检验分割法时,校正为α'=0.083。结果四组一般资料比较无统计学差异(P均>0.05)。在四个研究组中,小切口组手术时间、术中出血量、术后住院时间三项均值最短,依次为(55.70±13.91)min、(71.63±15.61)ml和(3.40±0.90)d。小切口组与内镜组比较在手术时间、术中出血量、术后疼痛评分、术后禁饮时间、术后住院时间上有统计学差异(P均<0.01),与开腹组比较在手术时间、术后疼痛评分、术后排气时间、术后住院时间上有统计学差异(P<0.05,P<0.01),与全腹腔镜组比较在术后并发症率、非计划内再手术或再入院率方面有统计学差异(P均<0.083)。结论腹壁小切口辅助腹腔镜治疗胃底贲门部肿瘤具有操作简单易行、创伤小、术后并发症少等优点。

Objective To evaluate the application value of laparoscopic resection with a subsidiary mini-incision in patients with gastric fundus-cardiac tumors. Methods The clinical data of 189 patients with gastric fundus-cardiac tumors operated with four different methods from June 2014 to June 2017 were retrospectively analyzed. All patients were divided into mini-incision group with laparoscopic resection with a subsidiary mini-incision（n = 43）,laparoscopic group（n = 37）,gastroscope group with resection under electronic endoscopy（n = 58） and laparotomy group（n = 51）. The general data（sex,age,tumor size and location,history of stomach diseases and preoperative upper gastrointestinal symptoms） and the indexes of prognosis（operation time,intraoperative blood loss,postoperative pain score,postoperative forbidden drinking and exhaust time,postoperative complications,postoperative hospital stay,unplanned reoperation and readmission rates）were compared among four groups. Results There were no statistical differences in the general data（all P〉0. 05）. There were significant differences in operation time（P = 0. 000）,intraoperative blood loss（P = 0. 000）,postoperative pain score（P = 0. 006）,postoperative forbidden drinking time（P = 0. 000）,postoperative hospital stay（P = 0. 000） between miniincision group and gastroscope group; there were significant differences in operation time（P = 0. 001）,postoperative pain score（P = 0. 000）,postoperative exhaust time（P = 0. 000） and postoperative hospital stay（P = 0. 018） between miniincision group and laparotomy group; there were significant differences in postoperative complications（P = 0. 015） and unplanned reoperation and readmission rates（P = 0. 008） between mini-incision group and laparoscopic group. Conclusion Laparoscopic surgery with a subsidiary mini-incision has the advantages of simple operation,small trauma,less postoperative complications.