手助腹腔镜与开腹、腹腔镜辅助远端胃癌根治术的临床对比研究  

Clinical comparison of hand assisted laparoscopic gastrectomy with laparotomy and laparoscopy assisted radical gastrectomy for distal gastric cancer

作　　者：张占学[1] 李忠[1] 张海强[1] 邱少凡[1] 王海军[1] 茹丽娜 王占文[1] 李涛[1] Zhang Zhanxue;Li Zhong;Zhang Haiqiang;Qiu Shaofan;Wang Haijun;Ru Lina;Wang Zhanwen;Li Tao(Department of Gastroenterological Surgery,Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院胃肠外科,石家庄050000

出　　处：《中华临床医师杂志（电子版）》2018年第4期212-217,共6页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的探讨手助腹腔镜在进展期远端胃癌根治术中的应用价值。方法回顾性分析河北医科大学第二医院2015年8月至2017年12月间80例进展期胃下部癌的临床资料,其中30例行手助腹腔镜手术,25例行开腹手术,25例行腹腔镜辅助手术。采用单因素方差分析比较3组之间手术时间、出血量、清扫淋巴结数目、术后排气时间、术后近期并发症、住院时间及住院费用、切口长度等指标的差异,组间的两两比较采用单因素方差分析中的Bonferroni方法。采用χ~2检验或Fisher确切概率法比较3组间性别、病理类型、腹主动脉旁有肿大淋巴结、腹部手术史及术后并发症的差异。结果 3种手术方式在术中淋巴结清扫数、术后住院费用及术后并发症方面比较,差异均无统计学意义(P>0.05);手助腹腔镜手术组、腹腔镜辅助手术组和开腹手术组3种手术方式在手术时间[(186.30±15.27)min vs (230.80±17.06)min vs (183.36±16.03)min]、术中出血量[(93.33±46.86)ml vs(98.80±55.10)ml vs (246.80±92.90)ml]、术后排气时间[(2.3±0.6)d vs (2.42±0.44)d vs(3.04±0.56)d]、住院时间[(8.90±1.19)d vs (9.40±1.44)d vs(10.92±1.73)d]及切口长度[(7.97±0.49)cm vs (8.04±0.61)cm vs (24.04±2.11)cm]方面比较,差异均具有统计学意义(F=70.055,43.937,20.162,13.892,1385.430,P均<0.001)。手助腹腔镜手术组和腹腔镜辅助手术组切口长度、术中出血量、术后排气时间及住院时间方面<开腹手术组,差异具有统计学意义(P均<0.001)。手助腹腔镜手术组和开腹手术组在手术时间方面较腹腔镜辅助手术组更短,且差异具有统计学意义(P均<0.001)。结论手助腹腔镜进展期远端胃癌根治术安全可行,其在肿瘤切除及淋巴结清扫上可达到与开腹手术相当的效果,并且不增加患者经济负担。手助腹腔镜手术保留了腹腔镜辅助手术的术中出血少、术后恢复快的优点,且手术时间短。Objective To evaluate the value of hand assisted laparoscopic radical resection for distal gastric cancer.Methods The clinical data of 80 patients with advanced gastric cancer from August 2015 to December 2017 were retrospectively analyzed.Among them,30 patients underwent hand-assisted laparoscopic surgery,25 patients underwent open surgery,and 25 patients underwent laparoscopic assisted surgery.The operative time,bleeding volume,number of recected lymph nodes,time to postoperative exhaust,postoperative complications,length of hospitalization,hospitalization expenses,length of incision and so on were compared among the three groups.The data were analyzed with SPSS 21.0 software.Measurement data are expressed as mean±standard deviation.ANOVA was used to compare measurement data,and the chi square test or Fisher exact test was used to compare count data.P<0.05 indicated that the difference was statistically significant.Results There was no significant difference in the number of recected lymph nodes,postoperative hospitalization expenses,or postoperative complications among the three groups(P>0.05).The hand-assisted laparoscopic surgery group,laparoscopy assisted surgery group,and open surgery group had significantly different operative time[(186.30±15.27)min vs(230.80±17.06)min vs(183.36±16.03)min],intraoperative bleeding volume[(93.33±46.86)mL vs(98.80±55.10)mL vs(246.80±92.90)mL],time to postoperative exhaust[(2.3±0.6)d vs(2.42±0.44)d vs(3.04±0.56)d],length of stay[(8.90±1.19)d vs(9.40±1.44)d vs(10.92±1.73)d],and incision length[(7.97±0.49)cm vs(8.04±0.61)cm vs(24.04±2.11)cm](P<0.001 for all).The length of incision,blood loss,time to postoperative exhaust,and hospital stay were significantly lower in the hand-assisted laparoscopic operation group and laparoscopically assisted operation group than in the open operation group(P<0.001).The operative time was significantly shorter in the hand-assisted laparoscopic surgery group and laparotomy group than in the laparoscopically assisted operation grou

关 键 词：手助腹腔镜 腹腔镜辅助 传统开腹术 进展期胃癌 

分 类 号：R735.2[医药卫生—肿瘤]