Clavien-Dindo分级在达芬奇机器人手术系统和腹腔镜辅助全胃D2根治术后近期并发症评估中的应用价值  

Application value of Clavien⁃Dindo classification in evaluation of postoperative short-term complications of Da Vinci robotic⁃assisted or laparoscopic⁃assisted total gastrectomy with D2 lymphadenectomy

作　　者：陈为凯 张安 吴金玲 祝爱敏 张瑄 李楠[2] 赵文芳 王新平[2] 王文安 王婧 于建平 陶瑞雨 李正凯 李坤[2] 李乐[2] 阎龙 曹廷宝[2] 魏登文 刘宏斌[2] Chen Weikai;Zhang An;Wu Jinling;Zhu Aimin;Zhang Xuan;Li Nan;Zhao Wenfang;Wang Xinping;Wang Wen′an;Wang Jing;Yu Jianping;Tao Ruiyu;Li Zhengkai;Li Kun;Li Le;Yan Long;Cao Tingbao;Wei Dengwen;Liu Hongbin(Clinical Medical College,Gansu University of Chinese Medicine,Lanzhou 730030,China;Department of General Surgery,the 940th Hospital of Joint Logistic Support Force of Chinese People′s Liberation Army,Lanzhou 730050,China;Gansu Provincial Key Laboratory of Stem Cells and Gene Drugs,Lanzhou 730050,China)

机构地区：[1]甘肃中医药大学临床医学院,兰州730030 [2]中国人民解放军联勤保障部队第九四○医院普通外科,兰州730050 [3]甘肃省干细胞与基因药物重点实验室,兰州730050

出　　处：《中华消化外科杂志》2020年第9期976-982,共7页Chinese Journal of Digestive Surgery

基　　金：国家科技部、财政部惠民计划资助项目(2012GS620101);甘肃省自然科学基金资助项目(1506RJZA309);甘肃中医药大学研究生创新基金资助项目(2019CX29、2019CX35)。

摘　　要：目的:探讨Clavien-Dindo分级在达芬奇机器人手术系统和腹腔镜辅助全胃D2根治术后近期并发症评估中的应用价值。方法:采用回顾性队列研究方法。收集2016年1月至2019年1月中国人民解放军联勤保障部队第九四○医院收治的262例胃癌患者的临床病理资料;男214例,女48例;年龄为(58±11)岁,年龄范围为17~81岁。262例患者中,120例行达芬奇机器人手术系统辅助全胃切除+D2淋巴结清扫+Roux-en-Y吻合术,设为机器人组;142例行腹腔镜辅助全胃切除+D2淋巴结清扫+Roux-en-Y吻合术,设为腹腔镜组。观察指标:(1)术中及术后情况。(2)术后病理学情况。(3)并发症情况。(4)分层分析。(5)随访情况。采用门诊和电话方式进行随访,了解患者术后2个月内并发症情况,肿瘤复发情况和生存情况。随访时间截至2019年5月。正态分布的计量资料以±s表示,组间比较采用t检验。偏态分布的计量资料以M(范围)表示,组间比较采用Mann-Whitney U检验。计数资料以绝对数或百分比表示,组间比较采用χ^2检验或Fisher确切概率法。等级资料组间比较采用秩和检验。结果:(1)术中及术后情况:机器人组患者中转开腹、手术时间、术中出血量、淋巴结清扫数目、术后首次肛门排气时间、术后首次进食流质食物时间、术后住院时间分别为1例、(243±42)min、100 mL(100~150 mL)、(38±15)枚、(2.8±1.0)d、3 d(3~4 d)、11 d(9~13 d);腹腔镜组患者上述指标分别为2例、(244±38)min、100 mL(100~150 mL)、(34±14)枚、(3.2±1.0)d、4 d(3~5 d)、10 d(9~13 d),两组患者淋巴结清扫数目、术后首次肛门排气时间、术后首次进食流质食物时间比较,差异均有统计学意义(t=2.068,-3.030,Z=-3.370,P<0.05);两组患者中转开腹、手术时间、术中出血量、术后住院时间比较,差异均无统计学意义(χ^2=0.000,t=-0.158,Z=-1.824,-0.088,P>0.05)。(2)术后病理学情况:机器人组患者高分化、中分化、低分Objective:To investigate the application value of Clavien-Dindo classification in evaluation of postoperative short-term complications of Da Vinci robotic-assisted or laparoscopic-assisted total gastrectomy with D2 lymphadenectomy.Methods:The retrospective cohort study was conducted.The clinicopathological data of 262 patients with gastric cancer who were admitted to the 940th Hospital of Joint Logistic Support Force of Chinese People′s Liberation Army from January 2016 to January 2019 were collected.There were 214 males and 48 females,aged(58±11)years,with a range from 17 to 81 years.Of 262 patients,120 cases undergoing Da Vinci robotic-assisted total gastrectomy+D2 lymphadenectomy+Roux-en-Y anastomosis were divided into robotic group,and 142 cases undergoing laparoscopic-assisted total gastrectomy+D2 lymphadenectomy+Roux-en-Y anastomosis were divided into laparoscopic group.Observation indicators:(1)intraoperative and postoperative situations;(2)postoperative pathological examination;(3)complications;(4)stratified analysis;(5)follow-up.Follow-up using outpatient examination and telephone interview was performed to detect complications,tumor recurrence and survival of patients within postoperative 2 months.The follow-up was up to May 2019.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was analyzed using the t test.Measurement data with skewed distribution were represented as M(range),and comparison between groups was analyzed using the Mann-Whitney U test.Count data were described as absolute numbers or percentages,and comparison between groups was analyzed using the chi-square test or Fisher exact probability.Comparison of ranked data between groups was analyzed using the rank sum test.Results:(1)Intraoperative and postoperative situations:cases undergoing conversion to open surgery,the operation time,volume of intraoperative blood loss,the number of lymph node dissected,time to first flatus,time to initial fluid diet intake,duration of postoperative hosp

关 键 词：胃肿瘤 全胃切除术 达芬奇机器人手术系统 并发症 危险因素 Clavien-Dindo分级 腹腔镜检查 

分 类 号：R735.2[医药卫生—肿瘤]