达芬奇机器人手术系统根治性全胃切除保脾脾门淋巴结清扫术的临床疗效

Clinical efficacy of Da Vinci robotic total gastrectomy combined with spleen-preserving splenic hilar lymphadenectomy for gastric cancer

目的探讨达芬奇机器人手术系统根治性全胃切除保脾脾门淋巴结清扫术的临床疗效。方法采用回顾性横断面研究方法。收集2016年9月至2018年6月福建医科大学附属协和医院收治的47例胃癌患者的临床病理资料;男37例,女10例;平均年龄为60岁,年龄范围为23~75岁。患者均行达芬奇机器人手术系统根治性全胃切除保脾脾门淋巴结清扫术。观察指标:(1)术中情况。(2)术后情况。(3)术后病理学检查情况。(4)随访情况。采用门诊、电话方式进行术后随访,了解患者术后生存情况。随访时间截至2018年9月。正态分布的计量资料以Mean±SD表示,偏态分布的计量资料以M(范围)表示。计数资料以绝对数表示。结果(1)术中情况:47例患者均行达芬奇机器人手术系统根治性全胃切除保脾脾门淋巴结清扫术,无中转开腹。47例患者手术时间、脾门淋巴结清扫时间、术中出血量、淋巴结清扫数目、脾门淋巴结清扫数目、淋巴结转移数目、脾门淋巴结转移数目分别为(225±36)min、(20±6)min、(40±27)mL、40枚(17~112枚)、2枚(0~10枚)、2枚(0~29枚)、0枚(0~3枚)。(2)术后情况:47例患者术后首次下床活动时间、术后首次肛门排气时间、术后胃管拔除时间、术后首次进食流质食物时间、术后首次进食半流质食物时间、术后引流管拔除时间、术后住院时间分别为(2.0±0.3)d、(3.4±0.9)d、(3.4±1.1)d、(4.8±1.0)d、(6.7±1.5)d、(8.5±2.5)d、(12.0±8.3)d。47例患者中,术后发生肺部感染、腹腔出血、吻合口漏、术后肠梗阻、腹腔感染分别为3、2、1、1、1例;并发症分级Ⅰ级、Ⅱ级、Ⅲ级分别为1、5、2例。患者30d内未发生死亡。2例腹腔出血患者均通过介入手术治疗痊愈,其余并发症均通过保守治疗痊愈。(3)术后病理学检查情况:47例患者肿瘤直径,淋巴结和(或)血管和(或)神经浸润,组织学分级(分化型、未分化型),T分期(T1期、T2期、T3期、T4期),N分期(N0期、N1期、N2期、N3期),TNM分期(Ⅰ期、Ⅱ期、Ⅲ期)分别为(4.2±1.6)cm,26例,31、16例,5、22、17、3例,18、9、8、12例,13、20、14例。(4)随访情况:47例患者均获得术后随访,随访时间为3~25个月,中位随访时间为9个月。随访期间,47例患者中,3例因肿瘤复发死亡,1例带瘤生存(吻合口肿瘤复发),43例无瘤生存。结论达芬奇机器人手术系统根治性全胃切除保脾脾门淋巴结清扫术安全、可行。

Objective To investigate the clinical efficacy of Da Vinci robotic total gastrectomy combined with spleen-preserving splenic hilar lymphadenectomy for gastric cancer. Methods The retrospective cross-sectional study was conducted. The clinicopathological data of 47 patients with gastric cancer who were admitted to Fujian Medical University Union Hospital from September 2016 to June 2018 were collected. There were 37 males and 10 females, aged from 23 to 75 years, with an average age of 60 years. Patients underwent Da Vinci robotic total gastrectomy combined with spleen-preserving splenic hilar lymphadenectomy. Observation indicators:(1) intraoperative situations;(2) postoperative situations;(3) postoperative pathological examination;(4) follow-up. Follow-up was conducted by outpatient examination and telephone interview to detect postoperative survival of patients up to September 2018. Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were expressed by M (range). Count data were represented as absolute numbers. Results (1) Intraoperative situations: 47 patients underwent Da Vinci robotic total gastrectomy combined with spleen-preserving splenic hilar lymphadenectomy for gastric cancer, without conversion to open surgery. The operation time, hilar lymph node dissection time, volume of intraoperative blood loss, number of lymph node dissected, number of splenic hilar lymph node dissected, number of metastatic lymph nodes, number of metastatic splenic hilar lymph node were (225±36) minutes,(20±6) minutes,(40±27) mL, 40 (range, 17-112), 2 (range, 0-10), 2 (range, 0-29), 0 (range, 0-3).(2) Postoperative situations: time to first out-of-bed activities, time to first anal flatus, time to gastric tube removal, time to initial liquid diet intake, time to initial semi-liquid diet intake, time to drainage tube removal, and duration of postoperative hospital stay were (2.0±0.3)days,(3.4±0.9)days,(3.4±1.1)days,(4.8±1.0)days,(6.7±1.5)days,(8.5±2.5)days, and (12.0±8.3)days, respectively. Of 47 patients, 3, 2, 1, 1, and 1 were detected pulmonary infection, abdominal bleeding, anastomotic fistula, postoperative intestinal obstruction, and abdominal infection. There were 1, 5, and 2 patients with complications in grade Ⅰ,Ⅱ, and Ⅲ of Clavien-Dindo classification. There was no death in the postoperative 30 days. Two patients with abdominal bleeding were cured by intervene therapy, and patients with other complications were cured by conservative treatment.(3) Postoperative pathological examination: tumor diameter, cases with nodal or vascular or neural invasion, cases with differentiated and undifferentiated tumor (histological differentiation), cases in T1, T2, T3, T4 stages (T staging), cases in N0, N1, N2, N3 stages (N staging), cases in Ⅰ,Ⅱ,Ⅲ stages (TNM staging) were (4.2±1.6)cm, 26, 31, 16, 5, 22, 17, 3, 18, 9, 8, 12, 13, 20, 14, respectively.(4) Follow-up: 47 patients were followed up for 3-25 months, with a median time of 9 months. During the follow-up, 3 of 47 patients died of tumor recurrence, 1 had tumor-bearing survival, and 43 had tumor-free survival. Conclusion Da Vinci robotic total gastrectomy combined with spleen-preserving splenic hilar lymphadenectomy for gastric cancer is safe and feasible.