网膜囊外入路全腹腔镜胃癌根治术对患者围术期指标、胃肠功能恢复及并发症的影响

Effects of total laparoscopic radical gastrectomy via external omental bursa approach on perioperative indexes,gastrointestinal function recovery and complications of patients

目的 探讨网膜囊外入路全腹腔镜胃癌根治术的临床疗效与安全性。方法 选取2017年10月~2019年3月于安徽医科大学第一附属医院收治的胃癌患者108例,按照非随机同期对照分组法分为经网膜囊外入路行全腹腔镜胃癌根治术者纳入外入路组(30例),经网膜囊内入路行全腹腔镜胃癌根治术者纳入内入路组(30例),行腹腔镜辅助胃癌D2根治术者纳入对照组(48例)。分析3组围术期指标、术后康复指标、术后1周内并发症发生情况、术后1个月时生活质量[生活质量问卷-胃癌22(QLQ-STO22)]、血清肿瘤标志物。结果 外入路组手术时间、淋巴结清扫总数目、第10组淋巴结清扫数均明显多于内入路组,而术中出血量明显少于内入路组,差异有统计学意义(P<0.05)。外入路组与内入路组恢复肠鸣音时间、恢复肛门排气时间、恢复进食时间、住院时间及术后1个月时QLQ-STO22评分均明显少于对照组,差异有统计学意义(P<0.05)。3组术后1周内并发症总发生率及1个月后血清肿瘤标志物水平比较差异均无统计学意义(P>0.05)。结论 网膜囊外入路全腹腔镜胃癌根治术兼具可行性与安全性,且能提高患者术后胃肠功能恢复效率,有利于改善其术后生活质量。

Objective To explore the clinical efficacy and safety of total laparoscopic radical gastrectomy via external omental bursa approach.Methods 108 patients with gastric cancer were enrolled for the study.According to non-randomized simultaneous control grouping,the patients undergoing total laparoscopic radical gastrectomy via external omental bursa approach were included in External group(n=30).The patients underwent total laparoscopic radical gastrectomy via internal omental bursa approach were included in Internal group(n=30),and patients who underwent laparoscopic assisted gastric cancer D2 radical surgery were included in control group(n=48).The perioperative indexes,postoperative rehabilitation indexes,occurrence of complications within 1 w after operation,quality of life at 1 month after operation[quality of life questionnaire-gastric cancer 22(QLQ-STO22)]and serum tumor markers were analyzed in the three groups.Results The operative time,total number of lymph node dissection,and the number of lymph node dissection in the 10th group in External group were significantly higher than those in Internal group,and the intraoperative blood loss was significantly less than that in Internal group(P<0.05).The bowel sound recovery time,anal exhaust recovery time,eating recovery time,hospital stay and QLQ-STO22 score at 1 month after operation in External group and Internal group were significantly lower than those in control group(P<0.05).There were no significant differences in the total incidence rate of complications within 1 week after operation and serum tumor markers after 1 month among the three groups(P>0.05).Conclusion Total laparoscopic radical gastrectomy via external omental bursa approach is feasible and safe,and can improve the recovery efficiency of postoperative gastrointestinal function,and it is beneficial to improve the postoperative quality of life.