轻中度慢性阻塞性肺疾病患者行腹腔镜与开腹胃癌根治性手术的安全性比较  

A Comparison Between Laparoscopy and Open Radical Resection for Gastric Carcinoma in Patients with Stage Ⅰ and Ⅱ Chronic Obstructive Pulmonary Disease

作　　者：王乐声[1] 洪建明[1] 陈培臻[1] 蔡丽生[1] 黄国平[1] 林小雷[1] 

机构地区：[1]福建医科大学附属漳州市医院普通外科,漳州363000

出　　处：《中国微创外科杂志》2015年第5期405-409,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的评估轻中度慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）患者行腹腔镜辅助胃癌根治术的安全性及可行性。方法回顾性分析我院2011年1月~2014年6月112例胃癌合并轻中度COPD患者的临床资料,按患者意愿分组,腹腔镜组44例,开腹组68例,比较2组术中呼气末CO2分压（PETCO2）、动脉血CO2分压（Pa CO2）、术后恢复及并发症。结果腹腔镜组术中PETCO2和Pa CO2均高于开腹组[（37.63±4.00）mm Hg vs.（34.72±2.85）mm Hg,t=4.491,P=0.000;（44.51±4.08）mm Hg vs.（41.95±5.24）mm Hg,t=2.747,P=0.007]。2组手术时间差异无显著性（P〉0.05）。腹腔镜组术中出血量、术中及术后输血率、术后镇痛次数、肛门排气时间、下床活动时间、术后住院时间均少于开腹组[（136.4±66.4）ml vs.（241.4±69.6）ml,t=-7.671,P=0.000;11.4%（5/44）vs.29.4%（20/68）,χ2=5.019,P=0.025;（2.1±0.9）次vs.（3.2±0.9）次,t=-5.151,P=0.000;（2.5±0.9）d vs.（3.4±1.0）d,t=-4.635,P=0.000;（3.3±0.9）d vs.（4.4±1.0）d,t=-5.876,P=0.000;（13.9±7.9）d vs.（17.4±8.6）d,t=-2.060,P=0.042]。2组术后肺部并发症、其他并发症发生率差异无显著性[27.3%（12/44）vs.29.4%（20/68）,χ2=0.060,P=0.807;13.6%（6/44）vs.14.7%（10/68）,χ2=0.025,P=0.874]。结论轻中度COPD患者行腹腔镜辅助下胃癌根治术是安全可行的。Objective To evaluate the feasibility and safety of laparoscopic radical gastrectomy for gastric cancer patients with stage Ⅰand Ⅱchronic obstructive pulmonary disease （COPD）. Methods A retrospective cohort study was made on patients with gastric cancer and stage Ⅰand Ⅱ COPD who underwent gastrectomy from January 2011 to June 2014 in our hospital .The patients were divided into two groups , with 44 cases in laparoscopy group （ LG group ） and 68 cases in open group （ OG group ） .The intraoperative PETCO2 and PaCO2, and postoperative recovery and complications of two groups were analyzed . Results The PETCO2 and PaCO2 in LG group during surgery were statistically higher than those in OG group [（37.63 ±4.00） mm Hg vs.（34.72 ±2.85） mm Hg, t=4.491, P=0.000; （44.51 ±4.08） mm Hg vs.（41.95 ±5.24） mm Hg, t =2.747, P=0.007].No significant differences were observed in operative time （P〉0.05）.In the aspect of intraoperative blood loss , rate of blood transfusion, the number of analgesic after surgery , first flatus time , ambulation time , and postoperative hospital stays , the LG group showed distinctive advantages than the OG group with statistically significant differences [（136.4 ±66.4） ml vs.（241.4 ±69.6） ml, t=-7.671, P=0.000;11.4%（5/44） vs.29.4%（20/68）,χ2 =5.019, P=0.025;（2.1 ±0.9） times vs.（3.2 ±0.9） times, t=-5.151, P=0.000;（2.5 ±0.9） d vs.（3.4 ±1.0） d, t=-4.635, P=0.000; （3.3 ±0.9） d vs.（4.4 ±1.0） d, t=-5.876, P=0.000;（13.9 ±7.9） d vs.（17.4 ±8.6） d, t =-2.060, P=0.042].There were no significant differences in incidence of postoperative pulmonary complications and the other complications between the LG and OG groups [ 27.3% （ 12/44 ） vs.29.4%（20/68）,χ2 =0.060, P=0.807;13.6% （6/44） vs.14.7% （10/68）, χ2 =0.025, P=0.874]. Conclusion Laparoscopic gastrectomy can be performed safely in patients with gastric cancer and stageⅠandⅡCOPD.

关 键 词：腹腔镜手术 胃癌 慢性阻塞性肺疾病 肺部并发症 

分 类 号：R735.2[医药卫生—肿瘤] R655.306[医药卫生—临床医学]