新型免气腹腔镜技术在高龄胃癌患者D2根治术的应用价值研究

Study of the clinical application value of new gasless laparoscopic D2 radical gastrectomy surgery in elderly patients with gastric cancer

目的:评价新型免气腹腔镜技术应用于高龄胃癌患者的安全性及有效性。方法 :选取2015年9月—2019年12月中国人民解放军总医院普通外科接受传统腹腔镜胃癌D2根治术(气腹组)或新型免气腹腔镜胃癌D2根治术(免气腹组)且年龄≥75岁的胃癌患者各20例。比较两组围手术期各项观察指标。结果:两组患者基线水平一致,术中呼气末CO2分压、平均气道压力、手术时间方面比较差异有统计学意义(P均<0.05),而在麻醉苏醒时间、淋巴结清扫数目、术中出血量、术中并发症发生率方面差异无统计学意义(P>0.05)。术后恢复过程中两组在胃管拔出时间、引流管拔出时间、排气时间、出现肩背痛患者比例及术后并发症方面差异无统计学意义(P>0.05),在术后住院时间上差异有统计学意义(P<0.05)。两组针对暴露效果的主观性评分差异未见统计学意义(P>0.05)。结论:与传统腹腔镜手术相比,新型免气腹腔镜胃癌根治术应用于高龄患者同样安全可行,且能避免气腹对心肺功能干扰,是高龄胃癌患者行微创根治手术的一种选择。

Objective: To compare the safety and efficacy of new gasless laparoscopic radical gastrectomy and traditional laparoscopic radical gastrectomy in elderly patients with gastric cancer. Methods: In this study, elderly GC patients(age≥75) cases underwent gasless laparoscopic radical gastrectomy(n=20) or traditional laparoscopic radical gastrectomy with CO2 pneumoperitoneum(n=20) were enrolled. Peri-operative surgical parameters and intra-operative cardiopulmonary/anesthesia changes were repeatedly measured and analyzed. Results: Patient baseline characteristics were comparable between the two groups. During the procedure, the mean end-tidal CO2(ET-CO2), mean airway pressure and the operation time were significantly different(P<0.05). The recovery time, number of lymph nodes dissected, intraoperative blood loss, intraoperative complication rate were comparable(P>0.05). There were no significant difference in the time of removing NG tube and drainage tube, exhaust time, the proportion of patients with shoulder pain and post-operative complication rate(P>0.05) between these two groups while the post-hospital stay was shorter in the gasless laparoscopic group(P<0.05). There was no statistical difference in the subjective score of surgical field between the two groups(P>0.05). Conclusion: The new gasless laparoscopic radical gastrectomy is similarly safe and feasible in elderly gastric cancer patients,compared with traditional laparoscopic radical gastrectomy. Moreover, it carries several advantages comparable to those of conventional pneumoperitoneum on peri-operative parameters. Therefore, it could be regarded as an alternative for elder GC patients with high cardiopulmonary risk.