功能型助手在腹腔镜胃癌根治术中的作用

Role of functional assistant in laparoscopic radical gastrectomy

目的:比较腹腔镜辅助胃癌根治术中功能型助手与支架型助手的作用。方法:回顾分析2017年1月至2019年12月收治的122例行腹腔镜辅助胃癌根治术(全胃切除,食管-空肠Roux-en-Y吻合术)患者的临床资料。其中,60例为支架型助手组(对照组),62例为功能型助手组(研究组)。对比分析两组围手术期及近期随访情况。结果:入组患者均顺利完成手术,无围手术期死亡病例。与支架型助手组相比,功能型助手组手术时间短[(208.1±34.8)min vs.(259.4±37.9)min,P<0.001],淋巴结清扫数量多[(30.2±7.4)枚vs.(26.0±6.4)枚,P=0.001],术中出血量少[(115.0±61.9)mL vs.(200.5±71.5)mL,P<0.001],切口短[(6.7±0.8)cm vs.(8.1±0.6)cm,P<0.001],首次进食流质早[(4.7±1.1)d vs.(5.2±1.3)d,P=0.033];两组首次排气时间[(3.8±0.9)d vs.(4.1±1.2)d,P=0.116]、引流管拔除时间[(9.0±2.5)d vs.(8.2±2.8)d,P=0.096]及术后住院时间[(10.7±2.8)d vs.(9.9±2.5)d,P=0.107]差异均无统计学意义。结论:功能型助手在腹腔镜辅助胃癌根治术中优势明显,与支架型助手相比,具有创伤小、出血少、手术时间短、淋巴结清扫更彻底等优势,近期效果显著。

Objective:To compare the role of functional assistants and stent-type assistants in laparoscopic-assisted radical gastrectomy for gastric cancer.Methods:The clinical data of 122 patients who received laparoscopic assisted radical gastrectomy(total gastrectomy,esophagus-jejunum Roux-en-Y anastomosis)from Jan.2017 to Dec.2019 were retrospectively analyzed.Among them,60 cases were in the stent-type assistant group(control group),and 62 cases were in the functional assistant group(research group).The perioperative condition and recent follow-up of the two groups were compared and analyzed.Results:Both groups successfully completed the operation without perioperative deaths.Compared with stent-type assistant group,operation time of functional assistant group[(208.1±34.8)min vs.(259.4±37.9)min,P<0.001]was significantly shortened,the number of dissected lymph node[(30.2±7.4)vs.(26.0±6.4),P=0.001]significantly increased,intraoperative blood loss[(115.0±61.9)mL vs.(200.5±71.5)mL,P<0.001]was significantly reduced,the incision length[(6.7±0.8)cm vs.(8.1±0.6)cm,P<0.001]was significantly shorter,the oral feeding time[(4.7±1.1)d vs.(5.2±1.3)d,P=0.033]was noticeably earlier.However,the first exhaust time[(3.8±0.9)d vs.(4.1±1.2)d,P=0.116],the extubation time[(9.0±2.5)d vs.(8.2±2.8)d,P=0.096]and the postoperative hospital stay[(10.7±2.8)d vs.(9.9±2.5)d,P=0.107]were not statistically significantly different.Conclusions:Compared with stent-type assistants,functional assistants have obvious advantages in laparoscopic-assisted radical gastric cancer surgery,such as fewer trauma,less bleeding,shorter operation time and more thorough lymph node dissection.The short-term effect is significant.