全腹腔镜与腹腔镜辅助在老年病人远端胃癌根治术中的应用效果对比

Effect of total laparoscopy and laparoscopic-assisted radical gastrectomy for distal gastric cancer in elderly patients

目的探讨全腹腔镜与腹腔镜辅助在老年病人远端胃癌根治术中的应用效果。方法以2021年1~8月桂林市第二人民医院收治的接受全腹腔镜远端胃癌根治术治疗的老年远端胃癌病人40例作为全腹腔镜组,另选择同期接受腹腔镜辅助远端胃癌根治术治疗的40例病人作为腹腔镜辅助组,术后均随访2周。回顾性收集其临床资料,统计2组术中、术后指标情况,术后1、2、3 d的疼痛情况以及随访期间的并发症发生情况。结果全腹腔镜组术中出血量低于腹腔镜辅助组,消化道吻合、术后排气、术后进食及术后住院时间均短于腹腔镜辅助组(P<0.05)。术后1、2、3 d,2组VAS评分呈逐渐降低趋势,且全腹腔镜组术后1、2、3 d的VAS评分均低于腹腔镜辅助组(P<0.05)。随访期间,全腹腔镜组切口感染、十二指肠残端瘘、淋巴漏、吻合口瘘发生率分别为2.50%、0、2.50%、0,与腹腔镜辅助组(5.00%、0、5.00%、2.50%)比较,差异均无统计学意义(P>0.05)。结论全腹腔镜与腹腔镜辅助远端胃癌根治术相比,可明显降低老年远端胃癌病人术中出血量,减轻术后疼痛,促进术后恢复,且安全性良好。

Objective To investigate the effect of total laparoscopy and laparoscopic-assisted radical gastrectomy in the elderly patients with distal gastric cancer.Methods A total of 80 elderly patients with distal gastric cancer admitted to the Second People’s Hospital of Guilin from January to August 2021 were divided into the laparoscopic-assisted group(n=40)and the total laparoscopic group(n=40)according to the treatment method.And the clinical data was collected retrospectively.Both groups were followed up for 2 weeks.The indicators before and after operation,the scores of visual analogue scale(VAS)1,2 and 3 d after operation and the complications during follow-up were compared between the two groups.Results The intraoperative blood loss in the total laparoscopic group was lower than that in the laparoscopic-assisted group,and the time of gastrointestinal anastomosis,exhaust,feeding and hospital stay were shorter than those in the laparoscopic-assisted group(P<0.05).The scores of VAS decreased in the two groups 1,2,3 d after operation,especially in the total laparoscopic group(P<0.05).During follow-up,the incidence rate of incision infection,duodenal stump fistula,lymphatic leakage and anastomotic fistula in the total laparoscopic group was 2.50%,0,2.50%and 0,respectively,compared with 5.00%,0,5.00%and 2.50%in the laparoscopic-assisted group(P>0.05).Conclusions Compared with laparoscopic-assisted radical gastrectomy for distal gastric cancer,total laparoscopy can significantly reduce the intraoperative blood loss in the elderly patients with distal gastric cancer,relieve pain and promote recovery,with high safety.