腹腔镜下全胃切除术与开腹全胃切除术后胃癌患者的并发症及手术相关指标分析  

Analysis of postoperative complications and operation related indexes of gastric cancer patients after laparoscopic total gastrectomy and open total gastrectomy

作　　者：曹斌[1] 董元强 陈志强[1] CAO Bin;DONG Yuanqiang;CHEN Zhiqiang(Department of General Surgery,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,Jiangsu,China)

机构地区：[1]南京医科大学第一附属医院普外科

出　　处：《癌症进展》2019年第23期2796-2799,共4页Oncology Progress

摘　　要：目的探讨腹腔镜下全胃切除术(LTG)对患者术后并发症的影响,以期为术后并发症的预防提供参考。方法选取221例行根治性全胃切除术的胃癌患者,根据手术方式的不同将患者分为传统开腹全胃切除术(OTG)组(n=114例)和LTG组(n=107)。比较两组患者的基本临床特征、术后1个月内的并发症发生情况和手术相关指标。结果两组患者的性别、年龄、术前血红蛋白水平、术前白蛋白水平、合并高血压情况、合并糖尿病情况比较,差异均无统计学意义(P﹥0.05)。两组患者术前行新辅助化疗情况比较,差异有统计学意义(P﹤0.01)。221例患者的术后并发症总发生率为23.1%(51/221),术后发热最常见,其次是胸腔积液和腹腔积液。OTG组共22例患者出现并发症,其中,出现Ⅱ级及以上并发症者17例,出现Ⅲ级及以上并发症者4例,死亡1例。LTG组共29例患者出现并发症,其中,出现Ⅱ级及以上并发症者20例,出现Ⅲ级及以上并发症者5例,无死亡病例。LTG组患者胸腔积液和吻合口瘘的发生率均高于OTG组患者(P﹤0.05)。结论术后住院时间长、住院费用、手术时间、肿瘤直径、淋巴结清扫数目、术中出血量等与胃癌患者的手术方式可能均有关,LTG术后并发症的Clavien-Dindo分级以Ⅱ级多见,LTG术后患者胸腔积液和食管吻合口瘘的发生率较高。Objective To explore the effect of laparoscopic total gastrectomy(LTG)on postoperative complications of gastric cancer patients.Method 221 cases of gastric cancer were divided into the traditional open total gastrectomy(OTG)group(n=114)and LTG group(n=107).The basic clinical characteristics,postoperative complications and operation related indexes of the two groups were compared.Result There was no significant difference in gender,age,hemoglobin level,albumin level,hypertension and diabetes between the two groups(P>0.05).The difference of neoadjuvant chemotherapy before operation between the two groups was statistically significant(P<0.01).The total incidence of postoperative complications in 221 patients was 23.1%(51/221).The most common complication was postoperative fever,followed by pleural effusion and peritoneal effusion.In the OTG group,there were 22 patients with complications,among them,17 patients hadⅡgrade and more complications,4 patients hadⅢgrade and more complications,and 1 patient was died.In the LTG group,29 patients had complications,among which 20 patients hadⅡgrade and more complications,5 patients hadⅢgrade and more complications,and there was no death.The incidence of pleural effusion and esophageal anastomotic leakage in LTG group was higher than that in OTG group(P<0.05).Conclusion The clinical characteristics of long postoperative hospital stay,hospital expense,operation time,tumor diameter,number of lymph node dissection,amount of intraoperative bleeding may be related to the operation mode of gastric cancer patients.Clavien-Dindo classification of complications after LTG was mostly gradeⅡ,and the incidence of pleural effusion and esophageal anastomotic leakage was high.

关 键 词：胃癌 腹腔镜 全胃切除术 并发症 吻合口瘘 

分 类 号：R735.2[医药卫生—肿瘤]