3D腹腔镜与2D腹腔镜辅助远端胃癌D2根治术的应用对比

Comparative study of 3D and 2D laparoscopic distal gastrectomy for patients with gastric cancer

目的比较3D腹腔镜与2D腹腔镜辅助远端胃癌根治术中的临床应用,探讨3D腹腔镜手段的可行性和安全性。方法选取2015年1月至2017年6月确诊为进展期胃癌并分别接受3D腹腔镜(3D组)和2D腹腔镜(2D组)D2辅助远端胃癌根治术的患者各34例,采用SPSS18.0统计软件进行统计学处理,术中及术后恢复指标及术后生活质量评分等计量资料以(x珋±s)表示,数据比较采用独立t检验;术后并发症及术后生存率等比较采用χ2检验或Fisher精确检验,以P<0.05为差异有统计学意义。结果与2D组比较,术后3D组出血量明显较少,淋巴结清扫数目明显更多,差异具有统计学意义(P<0.05);两组肛门排气时间、进流食时间、近切缘及远切缘距离、术后住院时间、术后并发症发生率、术后6个月生活质量评分以及1年、2年生存率等比较,差异均无统计学意义(均P>0.05)。结论相比2D腹腔镜手术,3D腹腔镜辅助下实施D2根治术可有效减少术中出血量,提高淋巴结清扫数目,方便医生操作使用,且不增加术后并发症或降低生存质量和生存率,值得在临床中推广使用。

Objective To compare the clinical outcome of 3D and 2D laparoscopic distal gastrectomy for patients with gastric cancer,and to explore the feasibility and safety of 3D laparoscopy.Methods From January 2015 and June 2017,68 patients diagnosed with advanced stomach cancer were enrolled in our hospital,including 34 cases in 3D group and 34 cases in 2D group.were compared between the two groups.Statistical analysis were performed by using SPSS18.0 software.Intraoperative and postoperative clinical indicators and quality of life score were presented as mean±standard deviation,and were examined by using t test;The postoperative survival and complication rate were compared withχ2 or Fisher test.P<0.05 was thought to be statistically significant. Results Compared with 2D group,there were less intraoperative bleeding and more harvested lymph nodes in 3D group,with significant differences(P<0.05).There were no significant differences between 2 groups in terms of exhaust time and liquid nurtrion recovery time,proximal and distal dissection margin,the postoperative hospital stay,and postoperative complications,as well as the EORTC QLQST022 score 6 month after surgery and 1-and 2-year survival rate(P>0.05). Conclusions 3D laparoscopic assisted D2 gastric cancer radical surgery is convenient to the surgeons,which could reduce the intraoperative blood loss and increase the number of removed lymph nodes.Besides,it does not increase postoperative complications as well as reduce life quality and survival rate,which is worth popularizing in clinical use.