3D、2D腹腔镜和开腹胃癌根治手术的近期临床疗效比较研究

Comparative study on short-term results of radical gastrectomy in gastric cancer patients:3D versus 2D laparoscopy or open surgery

目的:对比分析3D腹腔镜、2D腹腔镜及开腹三种胃癌根治手术病人的临床资料,研究3D腹腔镜胃癌根治术的临床优势和应用价值。方法:回顾性分析2013年1月至2018年1月期间上海东方肝胆外科医院治疗的450例胃癌病人临床资料,其中3D腹腔镜组126例,2D腹腔镜组219例,开腹组105例。对比分析三组病人的手术和术后恢复指标、术后并发症发生,以及术前和术后3 d血清炎性因子。结果:与开腹组相比,3D腹腔镜组、2D腹腔镜组的手术时间短、术中出血量少,肛门排气时间、下床活动时间、术后住院时间均短于开腹组(P<0.05)。3D腹腔镜组上述指标小于2D腹腔镜组(P<0.05)。三组淋巴结清扫量整体比较,差异无统计学意义(P>0.05)。术后3 d,开腹组血清C反应蛋白(CRP)、白细胞介素6(IL-6)和肿瘤坏死因子α水平均高于术前(P<0.05)。3D腹腔镜组、2D腹腔镜组血清CRP水平高于术前(P<0.05),且3D腹腔镜组、2D腹腔镜组血清炎性因子水平均低于开腹组(P<0.05)。3D腹腔镜组和2D腹腔镜组术后并发症总发生率均低于开腹组(P<0.05),而3D腹腔镜组与2D腹腔镜组的术后并发症总发生率比较,差异无统计学意义(P>0.05)。结论:腹腔镜胃癌根治手术可促进胃癌病人术后恢复。其并发症发生率低、炎性反应轻。3D腹腔镜胃癌根治手术时间最短、术中出血量最少,术后恢复较快。

Objective To compare clinical results in gastric cancer patients with radical gastrectomy among 3D laparoscopy, 2D laparoscopy and open surgery, and study the advantage of 3D laparoscopic radical gastrectomy. Methods Clinical data of 450 patients with gastric cancer in our hospital from January 2013 to January 2018 were analyzed retro-spectively including 126 cases in 3D laparoscopy group, 219 cases in 2D laparoscopy group and 105 cases in open surgery group. Surgical parameters, postoperative recovery and morbidity were compared among three groups combined with serum inflammatory factor before surgery and 3 days later. Results Less operative time and less operative blood loss were found in 3D laparoscopy group and 2D laparoscopy group comparing with those in open surgery group. Anal exhaust,ambulation and postoperative hospital stay in 3D laparoscopy group and 2D laparoscopy group were shorter than those in open surgery group(P<0.05). The intraoperative and postoperative parameters in 3D laparoscopy group were better than those in 2D laparoscopy group(P <0.05). There was no difference in the number of lymph node retrieved among three groups(P<0.05). Three days after operation, the levels of serum C-reactive protein(CRP), interleukin-6 and tumor necrosis factor-α in open surgery group were higher than those before operation(P<0.05). The levels of serum CRP in 3D and 2D laparoscopy group were higher than those before operation(P<0.05). The levels of serum inflammatory factors in 3 D and 2D laparoscopy group were lower than those in open surgery group(P<0.05). There was lower morbidity in 3D and 2D laparoscopy group than in open surgery group(P<0.05). However, no significant difference in morbidity was present between3 D and 2D laparoscopy group(P >0.05). Conclusions The patients with gastric cancer undergoing laparoscopic radical gastrectomy had faster recovery, less morbidity and mild inflammatory reaction with the most advantage in 3D laparoscopy gastrectomy, the shortest operation time, the least blood loss, the fastest recovery.