3D腹腔镜在腹腔镜辅助胃癌根治术中的应用价值

Application Value of Three Dimensional Laparoscopic-assisted Radical Gastrectomy

目的探讨3D腹腔镜在辅助性D2胃癌根治术的应用价值。方法采用前瞻性研究对2014年1月～2015年7月27例3D腹腔镜辅助胃癌根治术(3D组)与24例2D腹腔镜辅助胃癌根治术(2D组)的疗效进行比较。结果 3D组手术时间(183. 6±39. 5) min,与2D组(197. 8±36. 2) min差异无显著性(t=1. 332,P=0. 189);淋巴结清扫数目(32. 6±5. 3)枚,与2D组(29. 9±4. 3)枚差异无显著性(t=1. 982,P=0. 053);术中出血量(65. 9±28. 7) ml,显著少于2D组(88. 3±29. 2) ml(t=2. 759,P=0. 008);术后排气时间(72. 3±8. 3) h,与2D组(75. 3±9. 2) h差异无显著性(t=1. 224,P=0. 227);术后住院时间(8. 7±2. 2) d,与2D组(9. 3±2. 7) d无显著性差异(t=0. 874,P=0. 386);术后并发症发生率7. 4%(2/27),与2D组12. 5%(3/24)无显著性差异(χ~2=0. 019,P=0. 890);术后3 d平均腹腔引流量(47. 5±18. 3) ml,明显少于2D组(67. 3±23. 1) ml(t=3. 411,P=0. 001)。2组术后2年无瘤生存率无统计学差异(log-rank χ~2=0. 780,P=0. 377)。结论 3D腹腔镜D2胃癌根治术中出血量和术后腹腔引流量明显少于2D,两者疗效相当。

Objective To analyze clinical value of three dimensional laparoscopic-assisted radical D2 gastrectomy.Methods From January 2014 to July 2015,we performed 27 cases of radical D2 laparoscopic-assisted gastrectomy by employing Einstein Vision 3D laparoscopic system(3D group),as compared to 24 cases of two dimensional laparoscopic radical gastrectomy(2D group)to evaluate application value.Results The surgery time of the 3D group(183.6±39.5)min was slightly shorter than the 2D group[(197.8±36.2)min,t=1.332,P=0.189].There was no significant difference in average number of lymph node dissection between the 3D group(32.6±5.3)and the 2D group(29.9±4.3,t=1.982,P=0.053).The amount of bleeding in the 3D group(65.9±28.7 ml)was significantly lower than the 2D group(88.3±29.2 ml,t=2.759,P=0.008).There was no significant difference for postoperative complications incidence between the 3D group(7.4%)and the 2D group(12.5%,χ^2=0.019,P=0.890).There was no significant difference for postoperative exhaust time(72.3±8.3 h vs.75.3±9.2 h,t=1.224,P=0.227)and postoperative hospital stay(8.7±2.2 d vs.9.3±2.7 d,t=0.874,P=0.386)between the 3D group and 2D group.The postoperative volume of drainage in 3 days of the 3D group(47.5±18.3 ml)was significant less than the 2D group(67.3±23.1 ml,t=3.411,P=0.001).There was no significant difference in 2-year disease-free survival rate between the two groups(χ^2=0.780,P=0.377).Conclusion The 3D laparoscopic assisted D2 radical gastrectomy has less intraoperative blood loss and postoperative intraperitoneal drainage volume than 2D laparoscopic D2 radical gastrectomy,while both have equal effects.