手助腹腔镜在胃癌根治术中的应用

郭爱军; 鲁明典; 周波

doi:10.16766/j.cnki.issn.1674-4152.001994

手助腹腔镜在胃癌根治术中的应用

doi: 10.16766/j.cnki.issn.1674-4152.001994

安徽医科大学第一附属医院普外科，安徽合肥 230032

基金项目:

安徽省自然科学基金青年基金 1708085QH199

详细信息

通讯作者:
郭爱军, E-mail: anyifuyuangaj@126.com

中图分类号: R735.2 R730.56
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- 文章访问数: 73
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- 被引次数: 0
出版历程
- 收稿日期: 2020-11-12
- 网络出版日期: 2022-02-16

The application of hand-assisted laparoscopic D2 radical gastrectomy

Department of General Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230032, China

摘要

摘要: 目的探讨在胃癌手术中手助腹腔镜技术的临床应用。方法回顾性分析2018年1月—2020年12月期间在安徽医科大学第一附属医院胃肠外科治疗的60例胃癌患者的临床资料, 其中20例行手助腹腔镜手术, 20例行传统开腹手术, 其余20例行腹腔镜辅助手术, 分析比较3组之间手术时间、术中出血量、切口长度、术后排气时间、术后首次下床活动时间、住院时间、术中清扫淋巴结数目等指标的差异。结果 60例手术均顺利完成。分析发现，手助腹腔镜组与腹腔镜辅助组手术时间较开腹组较长[(239.7±22.2)min、(251.9±33.2)min、(184.1±37.2)min，F=26.309，P < 0.001]，但手助腹腔镜组与辅助腹腔镜组差异无统计学意义(P > 0.05)。手助腹腔镜组与腹腔镜辅助组较开腹组术中出血量少(F=68.984，P < 0.001)，且手助腹腔镜组较辅助腹腔镜组明显减少(P < 0.05)。手助腹腔镜组与腹腔镜辅助组较开腹组术中切口较小(F=675.937，P < 0.001)，但手助腹腔镜组与腹腔镜辅助组差异无统计学意义(P > 0.05)。手助腹腔镜组和腹腔镜辅助组术后排气时间、住院时间以及首次下床活动时间较开腹组均显著降低(均P < 0.001)，但2组比较差异无统计学意义(均P > 0.05)。3组患者淋巴结清扫数量差异无统计学意义(F=0.582，P=0.562)。结论手助腹腔镜技术集中了开放和腔镜的优势，对助手要求低，节约人力，患者创伤小、出血少、用时短、术后康复快、并发症少，是一种安全可行的术式。
- 胃癌 /
- 手助腹腔镜技术 /
- 并发症
Abstract: Objective To explore the clinical application of hand-assisted laparoscopic D2 radical gastrectomy (HALG) for the treatment of gastric cancer. Methods We retrospectively analyzed the clinical data of 60 patients with gastric cancer who were treated in the Department of Gastroenterology, First Affiliated Hospital of Anhui Medical University from January 2018 to December 2020, among which 20 patients underwent hand-assisted laparoscopic surgery, 20 underwent traditional open surgery, and 20 underwent laparoscopic assisted surgery. The differences in operative time, blood loss, incision length, postoperative discharge time, duration of first time to get out of bed after surgery, length of hospital stay, number of dissected lymph nodes and other indicators among the three groups were analyzed. Results All of the 60 operations were completed successfully. Results of the three groups showed that the operation time of the hand-assisted laparoscopic group and the laparoscopic assisted group were significantly longer than that of the traditional group [(239.7±22.2)min, (251.9±33.2)min, (184.1±37.2)min, F=26.309, P < 0.001], but there was no significant difference in the operation time between the hand-assisted laparoscopic group and laparoscopic assisted group (P > 0.05). The blood loss of the hand-assisted laparoscopic group and the laparoscopic assisted group were significantly less than that of the traditional group (F=68.984, P < 0.001), and the blood loss of the hand-assisted laparoscopic group was shorter than that of the laparoscopic assisted group (P < 0.05). The incision length of the hand-assisted laparoscopic group and the laparoscopic assisted group were significantly smaller than that of the traditional group (F=675.937, P < 0.001), but there was no significant difference between the hand-assisted laparoscopic group and the laparoscopic assisted group (P > 0.05). Postoperative exhaust time, length of hospital stay and duration of first time to get out of bed after surgery of the hand-assisted laparoscopic group and the laparoscopic assisted group longer than that of the traditional group (all P < 0.001), but there was no significant difference between the hand-assisted laparoscopic group and the laparoscopic assisted group (all P > 0.05). There was no significant difference in numbers of lymph nodes dissected among the 3 groups (F=0.582, P=0.562). Conclusion Hand-assisted laparoscopic D2 radical gastrectomy (HALG) combines the advantages of both open and laparoscopic-assisted radical gastrectomy. Compared with OG and LAG, HALG shows great advantages in lower requirements for assistants, less manpower, smaller incision, less intraoperation blood loss, quicker postoperative recovery and fewer complications. In conclusion, the HALG is a safe and feasible surgery.
- Gastric cancer /
- Hand-assisted laparoscopic D2 radical gastrectomy /
- Complications

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表 1 3组胃癌手术患者术中及术后情况比较(x ±s)

组别	例数	手术时长(min)	出血量(mL)	切口长度(cm)	清扫淋巴结数目(个)	住院时长(d)	术后排气时间(h)	术后下床时间(h)
开腹组	20	184.1±37.2	178.6±18.0	17.8±1.4	18.2±4.5	14.5±3.0	86.6±23.9	128.1±19.4
手助腹腔镜组	20	239.7±22.2^a	118.2±12.7^ab	6.1±0.6^a	17.7±4.9	12.5±1.9^a	67.5±6.5^a	63.7±6.6^a
腹腔镜辅助组	20	251.9±33.2^a	154.5±17.9^a	6.6±1.2^a	19.6±7.3	11.0±2.8^a	69.0±11.1^a	71.1±8.9^a
F值		26.309	68.984	675.937	0.582	9.284	9.203	149.119
P值		< 0.001	< 0.001	< 0.001	0.562	< 0.001	< 0.001	< 0.001
注：与开腹组比较，^aP < 0.05；与腹腔镜辅助组比较，^bP < 0.05。

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参考文献(15)

[1]	左婷婷, 郑荣寿, 曾红梅, 等. 中国胃癌流行病学现状[J]. 中国肿瘤临床, 2017, 44(1): 52-58. doi: 10.3969/j.issn.1000-8179.2017.01.881
[2]	李国新, 刘浩. 胃癌微创外科临床研究进展及展望(2000-2020)[J]. 中国实用外科杂志, 2020, 40(1): 62-64, 69. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWK202001012.htm
[3]	Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4. )[J]. Gastric Cancer, 2017, 20(1): 1-19. doi: 10.1007/s10120-016-0622-4
[4]	张英杰, 梁金荣. 腹腔镜胃癌根治术治疗进展期胃癌患者的近期疗效及对腹腔内微转移的影响[J]. 中华全科医学, 2017, 15(11): 1867-1869, 1890. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201711015.htm
[5]	林建贤, 郑朝辉, 黄昌明. 腹腔镜胃癌根治术淋巴结清扫中功能型助手配合技巧[J]. 中国实用外科杂志, 2018, 38(10): 1205-1207. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWK201810033.htm
[6]	何裕隆. 腹腔镜根治手术在胃癌中应用的现状与争议[J/CD]. 中华普外科手术学杂志(电子版), 2019, 13(2): 114-120.
[7]	高攀, 揭志刚, 李正荣, 等. 手辅助腹腔镜与腹腔镜辅助胃癌根治术的临床对照研究[J]. 实用医学杂志, 2019, 35(8): 1292-1295. doi: 10.3969/j.issn.1006-5725.2019.08.021
[8]	梁巍, 耿玮, 范亚男, 等. 全腹腔镜胃癌根治术在高龄患者手术中的安全性与可行性分析[J]. 河北医药, 2018, 40(11): 1671-1674. doi: 10.3969/j.issn.1002-7386.2018.11.017
[9]	LU Y M, LIN T, HU Y F, et al. Initial experience of dual-port laparoscopic distal gastrectomy for gastric cancer: A single- arm study[J]. Adv Ther, 2019, 36(9): 2342-2350. doi: 10.1007/s12325-019-01029-x
[10]	巩玉亮, 任博博. 腹腔镜与开腹胃癌根治术对患者术后免疫功能的影响[J]. 海南医学, 2020, 31(17): 2211-2214. doi: 10.3969/j.issn.1003-6350.2020.17.010
[11]	KATAI H, MIZUSAWA J, KATAYAMA H, et al. Short- term surgical outcomes from a phase Ⅲ study of laparoscopy-assisted versus open distal gastrectomy with nodal dissection for clinical stage ⅠA/ⅠB gastric cancer: Japan Clinical Oncology Group Study JCOG0912[J]. Gastric Cancer, 2017, 20(4): 699-708. doi: 10.1007/s10120-016-0646-9
[12]	陈贵兵, 徐晓倩, 龚加庆, 等. 手辅助腹腔镜与开腹胃癌根治术安全性及疗效比较的Meta分析[J]. 中华胃肠外科杂志, 2017, 20(3): 320-325. doi: 10.3760/cma.j.issn.1671-0274.2017.03.018
[13]	刘彬彬, 余革, 温晓晖, 等. 超声监测气管内全麻患者人工气腹下膈肌移动度和肺不张[J]. 实用医学杂志, 2019, 35(12): 1984-1988, 1992. doi: 10.3969/j.issn.1006-5725.2019.12.027
[14]	KINAMI S, FUNAKI H, FUJITA H, et al. Localresection of the stomach for gastric cancer [J]. Surg Today, 2017, 47(6): 651-659. doi: 10.1007/s00595-016-1371-z
[15]	李颖, 张铁峰, 蒋海斌, 等. 肺保护性通气用于老年腹腔镜结直肠癌手术患者的临床观察[J]. 中华全科医学, 2019, 17(10): 1673-1677. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201910017.htm