摘要
目的：探讨3D腹腔镜胃癌根治术的临床疗效。方法：采用回顾性横断面研究方法。收集2015年1月至2016年7月郑州大学人民医院收治的65例行3D腹腔镜胃癌根治术患者的临床资料。患者均行3D腹腔镜胃癌根治术，其手术步骤和术后治疗与传统2D腹腔镜胃癌根治术相同。观察指标：（1）手术情况：手术时间、术中出血量、淋巴结清扫数目。（2）术后恢复情况：术后肛门排气时间、术后进半流质饮食时间、术后住院时间、治疗费用、术后并发症。（3）术后病理学情况：胃癌病理学类型、T分期、淋巴结转移、TNM分期、手术标本切缘。（4）随访情况。采用门诊及电话方式进行随访，随访内容为患者术后生存及肿瘤转移、复发情况，随访时间截至2016年7月。正态分布的计量资料以±s表示；偏态分布的计量资料以M（范围）表示。结果：（1）手术情况：65例患者均顺利完成3D腹腔镜胃癌根治术、D2淋巴结清扫，无中转开腹手术，无术中并发症发生，无围术期死亡患者。65例患者手术时间为（200±55）min；术中出血量为（110±80）mL，清扫淋巴结数目为（32±7）枚/例。（2）术后恢复情况：65例患者术后肛门排气时间为（3.1±1.0）d，术后进半流质饮食时间为（5.3±1.6）d，术后住院时间为（9.4±3.0）d，治疗费用为（8.1± 1.3）万元。65例患者中，术后5例发生并发症，其中吻合口漏1例，再次手术行胃造瘘及腹腔引流术后痊愈；腹腔积液伴感染1例，行CT检查引导下置管引流后痊愈；短期胃排空障碍1例，对症治疗后痊愈；乳糜瘘1例，予短期禁食及全肠外营养支持治疗后痊愈；肺部感染1例，经抗感染治疗后痊愈。（3）65例患者术后病理学情况：①胃癌病理学类型：高中分化腺癌30例，低分化腺癌20例，印戒细胞癌11例，黏液腺癌 3例，乳头状腺癌1例；②T分期：T1期27例，T2期15例，T3期23例；③淋巴结转移25例，无淋巴结转移40例；④TNM分期：ⅠA期19例，ⅠB期17例，Ⅱ期15例，ⅢA期12例，ⅢB期2例。65例患者所有手术标本为R0切除，镜下切缘均为阴性。（4）随访情况：65例患者中，61例获得随访，随访时间为3～18个月，中位随访时间为9个月。随访期间，无手术相关并发症发生，无肿瘤转移、复发，无患者死亡。
Objective：To explore the clinical effect of threedimensional （3D） laparoscopic radical gastrectomy of gastric cancer.
Methods：The retrospective crosssectional study was conducted. The clinical data of 65 patients with gastric cancer who underwent 3D laparoscopic radical gastrectomy of gastric cancer in the People′s Hospital of Zhengzhou University from January 2015 to July 2016 were collected. There were the same surgical procedure and postoperative treatment between 3D and twodimensional （2D） laparoscopic radical gastrectomy of gastric cancer. Observation indicators： （1） surgical situations： operation time, volume of intraoperative blood loss, number of lymph node dissected; （2） postoperative recovery situations： time to anal exsufflation, time for semiliquid diet intake, duration of hospital stay, treatment expenses and postoperative complications; （3） postoperative pathological situations： pathological classification of gastric cancer, T stage, lymph node metastasis, TNM stage, surgical margin; （4） followup situations. The followup using outpatient examination and telephone interview was performed to detect patients′ survival and tumor metastasis and recurrence up to July 2016. Measurement data with normal distribution were represented as ±s. Measurement data with skewed distribution were described as M （range）. Results：（1） Surgical situations： all the 65 patients underwent successful 3D laparoscopic radical gastrectomy of gastric cancer and D2 lymph node dissection, without the occurrence of conversion to open surgery, intraoperative complications and perioperative death. Operation time, volume of intraoperative blood loss and number of lymph node dissected were （200±55）minutes, （110±80）mL and 32±7, respectively. （2） Postoperative recovery situations： time to anal exsufflation, time for semiliquid diet intake, duration of hospital stay and treatment expenses were （3.1±1.0）days, （5.3±1.6）days, （9.4±3.0）days and （8.1±1.3）×104 yuan, respectively. Of 65 patients, 5 had postoperative complications. One patient with anastomotic leakage underwent percutaneous endoscopic gastrostomy and abdominal drainage again and then was cured. One patient with peritoneal effusion and infection was cured after catheter drainage under CT guided. One patient with delayed gastric emptying was cured after symptomatic treatment. One patient with chylous fistula was cured after shortterm fast and total parenteral nutrition treatment. One patient with pulmonary infection was cured after antibiotic therapy. （3） Postoperative pathological situations： ① Pathological classification of gastric cancer： high and moderatedifferentiated adenocarcinoma was detected in 30 patients, poordifferentiated adenocarcinoma in 20 patients, signet ring cell carcinoma in 11 patients, mucinous adenocarcinoma in 3 patients and papillary adenocarcinoma in 1 patient. ② T stage： 27, 15 and 23 patients were in T1, T2 and T3 stages. ③ Twentyfive patients had lymph node metastases and 40 had no lymph node metastasis. ④ TNM stage： 19, 17, 15, 12 and 2 patients were in ⅠA, ⅠB, Ⅱ, ⅢA and ⅢB, respectively. R0 resection was performed to all the 65 patients, with negative surgical margin under the microscope. （4） Followup situations： of 65 patients, 61 were followed up for 3-18 months, with a median time of 9 months. During the followup, there was no occurrence of surgeryrelated complications, tumor metastasis and recurrence and death. Conclusion：The 3D laparoscopic radical gastrectomy of gastric cancer is safe and feasible, with a good shortterm outcome.
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2017年第3期257-261,共5页
Chinese Journal of Digestive Surgery
基金
河南省科技厅科技攻关项目（162102310308）
关键词
胃肿瘤
根治术
腹腔镜检查
3D技术
Gastric neoplasms
Radical gastrectomy
Laparoscopy
Three dimensional technology
