腹腔镜“三点两面法”入路在胃癌根治术中的临床应用

Application of laparoscopic "three points and two sides" approach in radical resection of gastric cancer

目的 :探讨腹腔镜胃癌手术"三点两面法"入路的可行性、方便性,安全性,寻找腹腔镜下胃癌根治术的最佳操作入路,避免或减少术中损伤失误的发生,以期达到最优效果。方法:收集2015年10月—2017年10月在我院同一手术组行腹腔镜胃癌手术170例,根据入路方式分别采用"三点两面法"入路组(观察组)81例及其他入路组(对照组)89例。比较两组患者手术时间、出血量,安全性,住院时间、术后胃肠功能恢复时间及胃肠吻合口漏发生率等。结果:观察组患者术中出血量、并发症发生率等少于对照组(P<0.05)。在远端胃切除术中,观察组术中出血量少于对照组(P<0.05),而两组手术时间、平均住院时间、并发症发生率差异无统计学意义(P>0.05)。在全胃切除术中,两组术中出血量、手术时间、平均住院时间、并发症发生率差异无统计学意义(P>0.05)。随切除范围的增加,观察组出血量、手术时间、平均住院时间、并发症发生率显著增加(P<0.05)。结论:与其他入路相比,"三点两面法"入路可有效减少术中出血量,不增加患者术后创伤。但随切除范围的增加,创伤程度显著增加。该入路定位符合解剖,术野层次清晰,显露操作准确,不易误入错误途径。解剖结扎血管安全,不易副损伤,出血量小,手术安全方便快捷。

Objective： To study ＂three spot two face method＂ the laparoscopic method of in Into the road, and other access methods for beginners laparoscopic gastric cancer surgery is easy to accept, convenience, safety and other aspects, to find out the best laparoscopic gastric cancer radi-cal operation into the road, to avoid or reduce intraoperatie damage failure occurs, the best approach to laparoscopic gastric cancer radical solution, in order to achieve the optimal effect. Methods： Collected in October 2015 to October 2017 in our hospital in the same line treatment of laparoscopic surgery clinical data of 170 patients with gastric cancer in gastric cancer, USES the method ＂three spot two face Method＂ in the of（observation group）81. and other approach group of 89 cases（control group）. To evaluate the efficacy of patients’ operation time, blood volume, safety, straying path, time of hospitalization, postoperative gastrointestinal function recovery and the incidence of gastrointestinal anastomosis. Results： The data of intraoperative bleeding, operation time, average hospitalization time and complications in the observation group were less than those in the control group（P 〈0.05）. The amount of intraoperative bleeding in the observation group was less than that in the control group（P 〈0.05）, but there was no significant difference in the operative time, average hospitalization time and complication between the two groups（P 〉0.05）. The operative time, average hospitalization time and complications were not significantly different（P 〉0.05）. With the increase of the range of resection,the blood loss, operation time and average hospital stay in the observation group were higher than those in the control group（P 〉0.05）. Complications increased significantly（P 〈0.05）. Conclusion：Compared with other approaches, the three-point approach can effectively reduce the amount of blood loss in the operation, without increasing the postoperative trauma. However, with the increase of excision range, the degree of trauma of the observation group increased significantly.This method can be used to locate the dissecting, the operation field is clear, the operation is accurate,not easy to go into the wrong way. The anatomical ligation vessel is safe, not easy to be injured,small amount of blood, safe and convenient operation and so on.