完全腹腔镜下远端胃癌根治术可行性临床研究

Clinical Study on the Feasibility of Radical Gastrectomy with Complete Laparoscopy for Distal Gastric Cancer

目的对比完全腹腔镜下远端胃癌根治术与开腹远端胃癌根治术的临床疗效,旨在论证完全腹腔镜在远端胃癌根治术手术中应用的安全性及可行性。方法回顾性分析2020年1月—2021年1月赤峰市医院肿瘤外科行远端胃癌根治术26例患者的临床资料,依据是否进行完全腹腔镜手术分为完全腹腔镜组(n=11)和开腹组(n=15)。依据术中出血量、手术时间、首次排气时间、首次下床活动时间、白蛋白及前白蛋白变化值、淋巴结清扫数目、切口长度等指标。结果两组淋巴结清扫数目均符合D2根治且数目均>15枚,均达到标准根治度。开腹组清扫数目优于完全腹腔镜组,差异有统计学意义(P<0.05)。完全腹腔镜组手术时间(268.00±31.43)min长于开腹组(199.00±23.58)min,差异有统计学意义(t=6.406,P<0.001);但完全腹腔镜术中出血量(77.27±51.78)mL少于开腹组(182.00±35.89)mL,差异有统计学意义(t=-6.102,P<0.001),切口创伤更小,差异有统计学意义(P<0.05)。术后完全腹腔镜组首次排气时间、首次下床时间短于开腹组,差异有统计学意义(P<0.05)。术后两组白蛋白及前白蛋白水平比较,差异无统计学意义(P>0.05),但腹腔镜组更优。结论完全腹腔镜下远端胃癌根治术在保证手术质量下具有创伤小、恢复快、腹部更美观等优势,完全腹腔镜下远端胃癌根治术是一种安全及可行的术式。

Objective To compare the clinical efficacy of radical gastrectomy with open distal gastrectomy under complete laparoscope,and to demonstrate the safety and feasibility of radical gastrectomy under complete laparoscope.Methods Clinical data of 26 patients who underwent radical gastrectomy for distal gastric cancer in Surgery Department of Chifeng Hospital from January 2020 to January 2021 were retrospectively analyzed,and they were divided into complete laparoscopic group(n=11)and laparotomy group(n=15)according to whether complete laparoscopic surgery was performed.Intraoperative blood loss,operation time,first exhaust time,first ambulation time,changes in albumin and prealbumin,number of lymph nodes dissection,incision length and other indexes were analyzed.Results The number of lymph node dissection in both groups met the D2 radical resection criteria,with a total number of>15,both reaching the standard degree of radical resection.The number of sweeps in the laparotomy group was higher than that in the endoscopic group,the difference was statistically significant(P<0.05).The surgical time in the complete laparoscopic group was(268.00±31.43)min longer than that in the open group(199.00±23.58)min,the difference was statistically significant(t=6.406,P<0.001);however,the bleeding volume during complete laparoscopic surgery(77.27±51.78)mL was lower than that in the open group(182.00±35.89)mL,the difference was statistically significant(t=-6.102,P<0.001),the incision wound was smaller,the difference was statistically significant(P<0.05).The first exhaust time and first bedtime in the postoperative complete laparoscopic group were shorter than those in the laparotomy group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the levels of albumin and prealbumin between the two groups after surgery(P>0.05),but the laparoscopic group is better.Conclusion Complete laparoscopic radical gastrectomy for distal gastric cancer has the advantages of less trauma,faster recovery and more beautiful abdomen under the guarantee of surgical quality.Complete laparoscopic radical gastrectomy for distal gastric cancer is a safe and feasible operation.