单孔加腹腔镜根治性全胃切除术的初步经验

Preliminary experience of single-incision plus laparoscopic radical total gastrectomy

目的:探讨单孔加腹腔镜根治性全胃切除术的近期疗效及初步技术经验。方法:回顾分析2018年7月至2021年11月收治的46例行单孔加腹腔镜根治性全胃切除术患者的临床资料,详细记录术前、术中及术后情况,并采用门诊与电话方式随访至术后30 d,了解患者术后生存情况。结果:均使用普通腹腔镜器械顺利完成手术,其中单孔加一孔腹腔镜根治性全胃切除术30例,单孔加二孔腹腔镜根治性全胃切除术16例,无一例中转为开腹或常规腹腔镜辅助手术,术后病理切缘均为阴性,手术时间平均(208.4±31.4)min,中位术中出血量30(四分位间距20.0)mL,无术中并发症发生。术后前3 d疼痛评分为(2.3±0.5)分、(1.9±0.6)分、(1.4±0.6)分,术后首次排气时间(53.4±12.1)h,术后腹腔引流管拔除时间(74.3±15.1)h,术后平均住院(8.5±1.3)d,辅助切口长度(4.2±0.5)cm,肿瘤近切缘距离为(3.7±2.3)cm,淋巴结清扫数量为(42.2±14.1)枚。术后30 d并发症发生率为8.7%(4/46),肺部感染2例,左胸腔积液、腹腔感染各1例。术后美容评分(20.1±1.7)分。患者均随访至术后30 d,生存良好。结论:在单孔腹腔镜技术娴熟的中心,使用普通腹腔镜器械行单孔加腹腔镜根治性全胃切除术是安全、可行的,具有疼痛轻及美容效果好的优势。

Objective:To investigate the short-term efficacy and preliminary technical experience of single-incision plus laparoscopic radical total gastrectomy.Methods:Clinical data of 46 patients who underwent single-incision plus laparoscopic radical total gastrectomy from Jul.2018 to Nov.2021 were retrospectively analyzed.The preoperative,intraoperative and postoperative conditions were recorded in detail.All patients were followed up for 30 d after the operation by outpatient service or telephone for postoperative survival.Results:All patients were successfully operated with conventional laparoscopic instruments,30 patients underwent single-incision plus one port and 16 cases underwent single-incision plus two ports laparoscopic radical total gastrectomy,no patient was converted to laparotomy or conventional laparoscopic-assisted surgery.The postoperative pathological margins were all negative,the average operation time was(208.4±31.4)min,the median intraoperative blood loss was 30 mL(interquartile range was 20 mL),and no intraoperative complications occurred.The pain score on the first three days after surgery were(2.3±0.5),(1.9±0.6),and(1.4±0.6),respectively.The postoperative exhaust time was(53.4±12.1)h,the time of removal abdominal drainage tube was(74.3±15.1)h,the average postoperative hospital stay was(8.5±1.3)d.The abdominal incision length was(4.2±0.5)cm.The distance of tumor to proximal incisional edge was(3.7±2.3)cm,and the number of lymph nodes harvested was(42.2±14.1).The incidence of complications in 30 d after operation was 8.7%(4/46),including 2 cases of pulmonary infection,1 case of left pleural effusion and 1 case of abdominal infection.Postoperative cosmetic score was(20.1±1.7).All patients were followed up for 30 d after surgery and survived well.Conclusions:Single-incision plus laparoscopic radical total gastrectomy with conventional laparoscopic instruments is safe and feasible in centers with experienced surgeons,this procedure has the advantages of light pain and satisfactory cosmetic effect.