手助腹腔镜与腹腔镜辅助远端胃癌根治术在进展期胃癌中的临床效果对比研究

Comparative study on the clinical effect of hand-assisted laparoscopic and laparoscopic-assisted radical gastrectomy for advanced gastric cancer

目的对比手助腹腔镜及腹腔镜辅助远端胃癌根治术在进展期胃癌中临床疗效及价值。方法回顾性分析2014年1月至2016年12月67例接受远端胃癌根治术的进展期胃癌患者资料。其中手助组34例,行手助腹腔镜远端胃癌根治术;腔镜组33例,行腹腔镜辅助远端胃癌根治术。采用统计学软件SPSS 18.0进行数据分析,围手术期指标、炎性反应、生活质量评分等以(x±s)表示,行独立t检验;临床分期、分化程度等行χ2检验;采用Kaplan-Meier法绘制两组2年无病生存率(DFS)及总生存率(OS)曲线图,用Log-rank检验进行远期生存分析,P<0.05表示差异有统计学意义。结果手助组比腔镜组手术时间短、术中出血量少(P<0.05)。术后3 d两组WBC计数及血清CRP、IL-6、TNF-a水平较术前显著升高,腔镜组升高幅度大于手助组(P<0.05)。术后1个月两组各项生活质量评分均降低,但手助组高于腔镜组(P<0.05)。术后6个月血红蛋白(Hb)水平手助组高于腔镜组(P<0.05),血清总蛋白(Tp)水平手助组低于腔镜组(P<0.05);术后12个月两组Hb、Tp、血清白蛋白含量(Alb)、营养指数(PNI)组间差异更加明显,差异均有统计学意义(P<0.05)。两组患者2年DFS和OS差异均无统计学意义(P>0.05)。结论手助腹腔镜远端胃癌根治术用时短、出血量少、术后恢复快,患者术后生活质量及预后营养水平更高,整体疗效优于腹腔镜辅助远端胃癌根治术。

Objective To compare the clinical efficacy and value of hand assisted laparoscopy and laparoscopy assisted radical gastrectomy for distal advanced gastric cancer.Methods Data of 67 patients with advanced gastric cancer who underwent distal radical gastrectomy from January 2014 to December 2016 were retrospectively analyzed.34 patients in the hand-assisted group received hand-assisted laparoscopic radi cal resection of distal gastric cancer.Laparoscopy assisted radical gastrectomy for distal gastric cancer was performed in 33 patients.Statistical software SPSS 18.0 was used for data analysis.Perioperative indicators,inflammatory response,and quality of life score were expressed as(x±s),and independent t test was performed.χ2 test was performed for clinical staging and degree of differentiation.Kaplan-meier method was used to draw 2-year disease-free survival rate(DFS)and overall survival rate(OS)curves of the two groups,and log-rank test was used for long-term survival analysis.P<0.05 was considered statistically significant.Results The hand group had shorter operation time and less intraoperative blood loss than the laparoscopy group(P<0.05).WBC count and serum CRP,il-6 and tnf-a levels were significantly increased in the two groups 3 days after surgery compared with those before surgery,and the increase in the laparoscopy group was greater than those in the hand-assisted group(P<0.05).All the scores of quality of life in the two groups were decreased 1 month after surgery,but the hand-assisted group was higher than the laparoscopy group(P<0.05).Six months after the operation,the Hb level of the hand AIDS group was higher than that of the endoscopy group(P<0.05),and the Tp level of the hand AIDS group was lower than that of the endoscopy group(P<0.05).The differences of Hb,Tp,Alb and PNI between the two groups were more obvious 12 months after surgery(P<0.05).There was no significant difference in 2-year DFS and OS between the two groups(P>0.05).Conclusion Hand-assisted laparoscopic radical gastrectomy for distal gastric cancer is shorter in time,less in blood loss,faster in postoperative recovery,higher in postoperative quality of life and prognostic nutrition of patients,and the overall efficacy is better than laparoscopic-assisted radical gastrectomy for distal gastric cancer.