3D与2D腹腔镜D2根治性全胃切除术的近期疗效对比研究

Comparative study of three-dimensional and two-dimensional laparoscopic D2 radical total gastrectomy in short-term efficacy

目的:探讨3D腹腔镜在D2根治性全胃切除术中的优势及近期疗效。方法:回顾分析2017年2月至2018年2月由同一组医师完成的3D(n=14)与2D(n=18)腹腔镜胃癌D2根治性全胃切除术的临床资料。对比两组手术时间、淋巴结清扫数量、术中出血量等手术指标,及术后并发症、术后排气时间、术后住院时间等近期疗效指标。结果:两组患者一般资料差异无统计学意义(P>0.05);两组均顺利完成手术,无一例中转开腹。3D组与2D组手术时间[(271.0±45.2)min vs.(278.6±53.6)min,t=0.352,P=0.731]差异无统计学意义;但3D组术中出血更少[(105.4±31.3)mL vs.(142.2±58.6)mL,t=2.123,P=0.042];淋巴结清扫数量更多[(28.6±10.6)枚vs.(21.1±8.2)枚,t=2.278,P=0.030]。两组术后排气时间[(3.1±0.7)d vs.(3.7±1.0)d,t=1.928,P=0.063]、术后住院时间[(11.2±2.2)d vs.(12.3±2.2)d,t=1.115,P=0.278]、术后并发症发生率[21.4%(3/14) vs. 27.8%(5/18),P=1.000]差异无统计学意义。结论:与2D腹腔镜相比,3D腹腔镜D2根治性全胃切除术在术中出血量、淋巴结清扫数量方面优势明显,值得临床进一步推广。

Objective:To evaluate the advantages and short-term efficacy of three-dimensional(3 D) laparoscopic D2 radical total gastrectomy in adenocarcinoma of the esophagogastric junction.Methods:Retrospective analysis was made on the clinical data of 32 patients who underwent laparoscopic D2 radical total gastrectomy from Feb.2017 to Feb.2018.Among the 32 patients,14 received 3 D and 18 received two-dimensional(2 D) technique respectively.All the surgeries were performed by the same team.The operation time,the number of retrieved lymph nodes,intraoperative blood loss,incidence of postoperative complications,time to first flatus,postoperative hospital stay and other short-term parameters were compared between the two groups.Results:There was no significant difference between the two groups in baseline data(P>0.05),all patients were successfully completed the operation without conversion to laparotomy.Compared with 2 D group,3 D group had more retrieved lymph nodes [(28.6±10.6) vs.(21.1±8.2),t=2.273,P=0.030],less intraoperative blood loss [(105.4±31.3)mL vs.(142.2±58.6)mL,t=2.123,P=0.042].Whereas no significant differences were found between the two groups in operation time [(271.0±45.2)min vs.(278.6±53.6)min,t=0.352,P=0.731],time to first flatus [(3.1±0.7)d vs.(3.7±1.0)d,t=1.928,P=0.063],hospital stay [(11.2±2.2)d vs.(12.3±2.2)d,t=1.115,P=0.278] or incidence of postoperative complications [21.4%(3/14) vs. 27.8%(5/18),P=1.000].Conclusionss:Three-dimensional laparoscopic D2 radical total gastrectomy may be advantageous over two-dimensional laparoscopic D2 radical total gastrectomy in intraoperative blood loss and the number of retrieved lymph node,this procedure is worthy of further clinical promotion.