胃癌患者完全3D腹腔镜与腹腔镜辅助全胃切除、食管空肠Roux-en-Y吻合术围术期疗效比较

Perioperative outcomes of complete 3D laparoscopy versus laparoscopic-assisted total gastrectomy and Roux-en-Y esophagojejunal anastomosis in gastric cancer patients

背景腹腔镜手术已获得普遍应用,但一部分研究者仍对完全腹腔镜技术持观望态度。目的 比较完全腹腔镜与腹腔镜辅助两种手术方式在根治性全胃切除、食管空肠Roux-en-Y吻合术的围术期疗效。方法 回顾性分析解放军总医院第一医学中心普通外科2018年1月-2020年12月采用根治性全胃切除、Roux-en-Y吻合术治疗的155例胃癌患者临床资料,年龄52~72岁,男性86例,女性69例,其中87例行完全腹腔镜手术(T组),68行腹腔镜辅助手术(L组)。比较两组手术时间、术中出血量、手术切口长度、术后拔除胃管时间、术后排气时间、总住院时间、吻合口瘘发生率、吻合口出血发生率、十二指肠残端瘘发生率、术后切缘阳性率、淋巴结检出数及阳性率等。结果 两组患者年龄、性别、体质量指数、肿瘤TNM分期等临床基线资料差异无统计学意义(P均>0.05);完全腹腔镜手术组的术中出血量[(58.20±38.80) mL vs (98.13±47.87) mL,P<0.05]、手术切口长度[(4.03±1.03) cm vs.(10.99±1.01) cm,P<0.05]、术后拔除胃管时间[(13.43±1.57) h vs (63.01±21.29) h,P<0.05]、术后排气时间[(40.08±19.98) h vs (64.58±28.08) h,P<0.05]、总住院时间[(7.55±1.55) d vs (8.97±2.03) d,P<0.05]均优于腹腔镜辅助手术组;而两组在手术时间、淋巴结阳性检出率和术后近期并发症发生情况等方面的差异无统计学意义(P均>0.05)。结论 完全3D腹腔镜根治性全胃切除、食管空肠Roux-en-Y吻合术可以达到更好的临床效果,与腹腔镜辅助手术方法相比有手术创伤小、恢复快的特点。

Background Laparoscopic surgery has been widely used, but some scholars still hold a wait-and-see attitude to the complete laparoscopic technique. Objective To compare the perioperative efficacy of complete laparoscopy versus laparoscopicassisted surgery combined total gastrectomy and Roux-en-Y esophagojejunal anastomosis. Methods A retrospective analysis was performed on the clinical data about 155 cases of gastric cancer treated by radical gastrectomy and Roux-EN-Y anastomosis in the First Medical Center of Chinese PLA General Hospital from January 2018 to December 2020. There were 86 males and 69 females with age range of 52-72 years, 87 cases underwent complete laparoscopic surgery(T group) and 68 cases underwent laparoscopic assisted surgery(L group). The operative time, intraoperative blood loss, surgical incision length, postoperative gastric tube extraction time, postoperative exhaust time, total length of stay, incidence of anastomotic fistula, incidence of anastomotic bleeding,incidence of duodenal stump fistula, postoperative pathological report of resection margin positive rate and lymph node detection number and positive rate were compared between the two groups. Results There were no statistically significant differences in age,gender, BMI, TNM stage and other clinical baseline data between the two groups(all P>0.05). Compared with the laparoscopic assisted surgery group, the intraoperative blood loss([58.20±38.80] mL vs [98.13±47.87] mL, P< 0.05), incision length([4.03±1.03] cm vs [10.99±1.01] cm, P< 0.05), postoperative gastric tube removal time([13.43±1.57] h vs [63.01±21.29] h,P<0.05), postoperative exhaust time([40.08±19.98] h vs [64.58±28.08] h, P<0.05), total length of hospital stay([7.55±1.55] d vs[8.97±2.03] d, P<0.05) were better in the complete 3D laparoscopic surgery group. There were no statistical differences between the two groups in terms of operation time, positive lymph node detection rate and postoperative complications(P> 0.05).Conclusion Complete 3D laparoscopic radical gastrectomy and Roux-en-Y anastomosis of esophagus and jejunum can achieve better clinical results, and it has the characteristics of small surgical trauma and quick recovery.