多种全腹腔镜与腹腔镜辅助全胃切除术短期疗效及并发症比较研究

Comparative Study of Short-term Efficacy and Complications Between Various Total Laparoscopic and Laparoscopic-assisted Total Gastrectomy

目的分析比较腹腔镜辅助全胃切除术与全腹腔镜全胃切除术对胃癌患者的短期疗效及并发症。方法采取回顾性队列研究方法,收集2016年1月1日—2021年12月31日入院,接受腹腔镜全胃切除术的Ⅰ-Ⅲ期胃癌患者临床病理资料。共纳入291例患者,根据手术方式分为腹腔镜辅助全胃切除术组(n=157)和全腹腔镜全胃切除术组(n=134),其中包括π组(n=60),overlap组(n=43),反穿刺组(n=31);四组患者的年龄、性别、体质指数、肿瘤部位、分化程度、肿瘤长径、肿瘤T分期、肿瘤N分期和肿瘤病理分期,差异均无统计学意义(均P>0.05),具有可比性。观察指标:(1)手术及术后情况;(2)术后并发症情况:术后需要保守治疗或手术干预的任何不良情况。结果与其余各组组相比,反穿刺组辅助切口更小[3.5(1.0)cm vs.6.0(4.0)cm vs.6.0(1.0)cm vs.6.0(1.0)cm,H=97.01,P<0.05],切缘更高[4.0(2.0)cm vs.1.5(2.0)cm vs.1.5(2.0)cm vs.1.5(2.0)cm,H=46.63,P<0.05],差异具有统计学意义。与腹腔镜辅助组相比,反穿刺组手术时间明显更短[250(119)min vs.193(80)min,H=9.15,P<0.05]。在术后并发症方面,各组间差异无统计学意义(P>0.05)。结论反穿刺法较π吻合、overlap吻合、腹腔镜辅助手术,其手术时间更短、切缘更高、辅助切口更小,更加微创。与腹腔镜辅助全胃切除术相比,overlap法及π吻合同样能保障手术的肿瘤学安全,且并不会增加患者的术后并发症,并且能够相对微创。

Objective To compare the short-term outcomes and postoperative complications of laparoscopic-assisted total gastrectomy and various total laparoscopic total gastrectomy for gastric cancer.Methods A retrospective cohort study was conducted to collect the clinicopathological data of patients with stageⅠ-Ⅲgastric cancer who underwent laparoscopic total gastrectomy from January 1,2016 to December 31,2021.A total of 291 patients were enrolled and divided into laparoscopic-assisted total gastrectomy group(n=157)and total laparoscopic total gastrectomy group(n=134)according to the surgical method,includingπ-shaped method group(n=60),overlap method group(n=43)and reverse puncture device group(n=31).There were no significant differences in age,gender,body mass index,tumor location,degree of differentiation,tumor length,tumor T stage,tumor N stage and tumor pathological stage among the four groups(all P>0.05),which were comparable.Observation indicators:(1)Operation and postoperative conditions.(2)Postoperative complications:any adverse conditions requiring conservative treatment or surgical intervention after surgery.Results Compared with the other groups,the auxiliary incision size in the reverse puncture group was smaller[3.5(1.0)cm vs.6.0(4.0)cm vs.6.0(1.0)cm vs.6.0(1.0)cm,H=97.01,P<0.05],and the incision margin was higher[4.0(2.0)cm vs.1.5(2.0)cm vs.1.5(2.0)cm vs.1.5(2.0)cm,H=46.63,P<0.05],the difference was statistically significant.Compared with the laparoscopy-assisted group,the operation time of the reverse puncture group was significantly shorter[250(119)min vs.193(80)min,H=9.15,P<0.05].There were no statistically significant differences in postoperative complications between the groups(P>0.05).Conclusion Compared withπ-shaped method,overlap method and laparoscopic-assisted surgery,reverse puncture device has shorter operation time,higher incision margin,smaller auxiliary incision and is more minimally invasive.Compared with laparoscopic-assisted total gastrectomy,overlap method andπ-shaped method can also ensure the safety of oncology,and do not increase the postoperative complications of patients,and can be relatively minimally invasive.