摘要
目的研究完全腹腔镜远端胃切除术（TLDG）的可行性、有效性、安全性。方法回顾性分析2013年1月至2014年1月行TLDG 70例与腹腔镜辅助胃癌根治术（LADG）68例患者的临床资料,手术均由同一组术者实施。应用SPSS 18.0软件对数据进行统计学分析,平均手术时间、术中平均出血量、平均淋巴结清扫数目、首次通气时间、平均住院时间、止痛剂使用量采用t检验;中转开腹率、并发症发生率采用χ2检验。P〈0.05为差异有统计学意义。结果手术均顺利完成。TLDG组与LADG组相比,平均手术时间、术中平均出血量、平均淋巴结清扫数目、中转开腹率差异无统计学意义（P〉0.05）。TLDG组与LADG组比较：术后首次通气时间（2.4±1.3）d比（3.5±1.6）d,术后平均住院时间（10.7±2.5）d比（12.5±2.3）d,术后止痛剂使用量（1.8±0.9）支比（3.5±0.6）支,TLDG组均少于LADG组,差异有统计学意义（t=4.438、4.398、13.017,P〈0.01）。术后并发症发生率（7.1%比5.9%）两组差异无统计学意义（P〉0.05）。两组均无手术死亡病例发生,随访时间1~12个月（平均随访时间8.7个月）,无肿瘤复发或转移。结论相较于LADG组,TLDG在达到胃癌D2根治临床效果的同时,还使患者术后通气时间早,住院时间缩短,术后疼痛轻,可作为胃癌患者一种理想的手术方法。
Objective To investigate the feasibility, efficacy and safety of total laparoscopic D2 distal gastrectomy for gastric cancer. Methods A retrospective analysis was performed in 138 patients with gastric cancer in our hospital from July 2013 to June 2014. Among this series, 70 patients had received total laparoscopic distal gastrectomy （TLDG） and 68 underwent laparoscopie-assisted distal gastrectomy （LADG）. All patients were operated on by one group of experienced surgeons. Statistical analysis of clinical data was performed using software SPSS18.0. Data between the two groups were compared by Student＇s t test, including average operation time, intraoperative blood loss, number of lymph nodes, time of the first flatus, postoperative hospital stay, and dosage of pain killers. The rate of conversion to laparotomy and the incidence of complications were compared by the chi-square test. P 〈 0. 05 was considered statistically significant. Results The surgical procedures were performed successfully. Clinical outcomes of the TLDG group, such as average operation time, intraoperative blood loss, number of lymph nodes dissected, and rate of conversion to laparotomy were as good as those in the LADG group （ P 〉 0. 05 ）. The time of the first flatus [（2.4 ±1.3） μ vs （3.5 ±1.6） μ], postoperative hospital stay [（10.7 ±2.5） μ vs （12.5 ±2.3） μ], dosage of pain killers [ （ 1.8 ± 0. 9 ）μ vs （ 3.5 ± 0. 6 ） μ ] were significantly shorter or less in the TLDG group compared with the LADG group （t = 4. 438, 4. 398, 13. 017, P 〈 0. 01）. The incidence of complications was not statistically significant between the two groups （7. 1% vs 5.9% ）. Follow-up for 1 - 12 months （average 8.7 months） revealed no local recurrence and metastasis. Conclusion Compared with LADG, TLDG for gastric cancer is a safe and feasible procedure which could achieve equivalent outcome with minimal invasion, faster recovery, less blood loss and shorter hospital stay.
出处
《中华普外科手术学杂志（电子版）》
2015年第2期26-29,共4页
Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)
基金
湖北省自然科学基金(2010CDB09202)
武汉市科研计划项目(2013062301010821)~~
关键词
胃肿瘤
腹腔镜检查
胃切除术
Stomach neoplasms
Laparoscopy
Gastrectomy
