全腹腔镜和腹腔镜辅助远端胃癌根治术短期疗效的对比研究

A comparative study of short-term clinical outcomes of total laparoscopic and laparoscopic- assisted radical resection of distal gastric cancer: a propensity score-matched analysis

目的分析全腹腔镜远端胃切除术(TLDG)和腹腔镜辅助远端胃切除术(LADG)联合Billroth-Ⅱ+Braun吻合术的短期临床疗效。方法回顾性分析2020年1月至2022年10月在山东第一医科大学附属省立医院接受腹腔镜远端胃切除术联合Billroth-Ⅱ+Braun吻合术124例患者的临床资料,根据手术方式的不同将其分为TLDG组(n=62)和LADG组(n=62),比较两组患者术中情况及术后并发症发生情况。结果与LADG组比较,TLDG组在第1次排气时间[(2.9±1.3)比(2.3±0.8)d,Z=-3.072,P=0.002]、第1次进流质饮食时间[(5.9±1.3)比(5.4±1.4)d,Z=-2.031,P=0.042]和切口长度[(7.1±1.4)比(4.8±0.8)cm,Z=-6.331,P=0.000]方面差异均有统计学意义。TLDG组和LADG组术后总并发症发生率差异无统计学意义(29%比37%,χ^(2)=0.911,P=0.340)。TLDG组术后肺炎发生率较LADG组更低(3%比13%,χ^(2)=3.916,P=0.048)。TLDG组和LADG组术后严重并发症发生率差异无统计学意义(P=1.000)。多因素分析显示男性(P=0.023)和年龄≥65岁(P=0.001)是影响术后并发症发生的独立危险因素。结论TLDG安全可行,短期临床疗效优于LADG。

Objective To analyze the short-term clinical outcomes of total laparoscopic distal gastrectomy(TLDG)and laparoscopic-assisted distal gastrectomy(LADG)combined with Billroth-Ⅱ+Braun anastomosis.Methods Clinical characteristics of patients undergoing laparoscopic distal gastrectomy combined with Billroth-Ⅱ+Braun anastomosis at Department of Gastrointestinal Surgery,Shandong Provincial Hospital Affiliated to Shandong First Medical University from Jan 2020 to Oct 2022 were analyzed.Patients were divided into TLDG group(n=62)and LADG group(n=62)according to the surgical approach.Results There were significant differences in the preoperative clinical data section between the two groups,and 124 patients(62 in each group)were enrolled after using propensity score matching to balance significant variables.Compared with the LADG group,the TLDG group showed statistically differences in time to first venting[(2.9±1.3)vs.(2.3±0.8)d,Z=-3.072,P=0.002],time to first fluid diet[(5.9±1.3)vs.(5.4±1.4)d,Z=-2.031,P=0.042]and incision length[(7.1±1.4)vs.(4.8±0.8)cm,Z=-6.331,P=0.000].Total postoperative complication rate in the TLDG group and the LADG group(29%vs.37%,χ^(2)=0.911,P=0.340)was not statistically significant.Incidence of postoperative pneumonia was lower in the TLDG group than in the LADG group(3%vs.13%,χ^(2)=3.916,P=0.048),and incidence of all remaining postoperative complications were not statistically significant.There was no statistically significant difference in the incidence of serious postoperative complications between the TLDG and LADG groups(P=1.000).Multifactorial analysis revealed that male(P=0.023)and age≥65 years(P=0.001)were independent risk factors for postoperative complications.Conclusion TLDG is safe and feasible and has better short-term clinical efficacy than LADG.