纯单孔腹腔镜胃癌根治术围手术期的安全性及可行性分析

Analysis on perioperative safety and feasibility of pure single-port laparoscopic distal gastrectomy for gastric cancer

目的研究纯单孔腹腔镜远端胃癌根治手术围手术期的安全性和可行性。方法采用基于倾向评分匹配的回顾性队列研究方法。研究对象纳入影像检查和病理诊断为早期远端胃癌、无远处转移、无严重心脑血管等疾病和实施胃癌根治术者;排除临床资料不完整、非计划二次手术者及合并其他肿瘤者。回顾性收集2020年9月至2022年3月期间,行纯单孔腹腔镜胃癌根治术(纯单孔手术组)15例患者的临床资料;同时收集同期行常规5孔腹腔镜远端胃癌根治术(常规5孔手术组)58例患者的临床资料作为对照。由于发现两组患者的基线资料中,体质指数的比较差异有统计学意义[(20.8±0.8)kg/m^(2)比(22.9±0.4)kg/m^(2),t=2.456,P=0.017],故对两组患者进行1∶1倾向性评分匹配后,对两组患者围手术期的基本情况进行分析比较。结果纯单孔手术组和常规5孔手术组经倾向评分匹配后,各有14例患者。两组在术中出血量、淋巴结清扫总数、术后首次进食时间和术后并发症发生率方面,差异均无统计学意义(均P>0.05)。纯单孔手术组手术时间长于常规5孔手术组[(163.6±6.3)min比(133.9±4.4)min,t=3.866,P=0.001],但术后首次排气时间[(2.6±0.2)d比(3.3±0.1)d,t=3.053,P=0.005]、引流管拔管时间[(4.5±0.8)d比(6.9±0.2)d,t=2.914,P=0.007]和术后住院时间[(6.7±0.1)d比(9.2±1.0)d,t=2.534,P=0.018]明显短于常规5孔手术组,纯单孔手术组术后第1天疼痛数字评价量表(NRS)评分[(1.86±0.29)分比(2.86±0.35)分,t=2.205,P=0.037]低于常规5孔手术组,差异均有统计学意义。纯单孔手术组有4例患者术后未放置腹腔引流管,均安全康复。结论纯单孔腹腔镜胃癌根治术安全、可行,并在术后恢复方面具有一定优势。

Objective To investigate the safety and feasibility of pure single-port laparoscopic distal gastrectomy(SDG)in the radical treatment of gastric cancer.Methods A retrospective cohort study with propensity score matching(PSM)was conducted.Subjects were included in the study who were diagnosed by imaging examination and pathology as early distal gastric cancer,no distant metastasis,no serious cardiovascular and cerebrovascular diseases and underwent radical gastrectomy.Patients with incomplete clinical data,unplanned second operation and complicated with other tumors were excluded.A retrospective analysis was performed on 15 patients who underwent pure SDG radical gastrectomy for gastric cancer from September 2020 to March 2022,namely the SDG group.Fifty-eight patients undergoing conventional five-port laparoscopic radical gastrectomy for gastric cancer were included as the control group,namely the LDG group.As it was found that there was a statistically significant difference in baseline body mass index(BMI)between the two groups[(20.8±0.8)kg/m^(2) vs.(22.9±0.4)kg/m^(2),t=2.456,P=0.017],one-to-one PSM was conducted between the two groups.Then the basic conditions of the two groups of patients in perioperative period were analyzed and compared.Results There were 14 patients after PSM in the SDG group and the LDG group respectively.There were no significant differences in intraoperative bleeding,number of lymph nodes dissected,time to the first postoperative feeding and postoperative complications between the SDG group and the LDG group(all P>0.05).Compared with LDG group,the operative time in the SDG group was longer[(163.6±6.3)minutes vs.(133.9±4.4)minutes,t=3.866,P=0.001].However,in the SDG group,time to the first flatus[(2.6±0.2)days vs.(3.3±0.1)days,t=3.053,P=0.005],time to drainage tube removal[(4.5±0.8)days vs.(6.9±0.2)days,t=2.914,P=0.007)]and postoperative hospital stay[(6.7±0.1)days vs.(9.2±1.0)days,t=2.534,P=0.018)]were significantly shorter,and pain score at the first postoperative day evaluated by NRS(1.86±0.29 vs.2.86±0.35,t=2.205,P=0.037)was significantly lower as compared to the LDG group.Four patients in SDG group did not receive peritoneal drainage tube placement after surgery,and they all recovered safely.Conclusion The pure single-port laparoscopic radical gastrectomy for gastric cancer is safe and feasible,and has an advantage over the LDG in postoperative recovery.