达芬奇机器人与腹腔镜胃癌根治术围手术期疗效与营养状况的对比分析  

Comparative analysis of clinical efficacy and nutrition between Da Vinci robot and laparoscopic radical gastric cancer surgery

作　　者：张安 王文安 王婧[1,2] 曹小萌[1,2] 王菲 袁绍斌[1,2] 汪文杰 郭长安[2,4] 刘志昌 徐子鹏 余稳稳[2,4] 周海存 于建平 李乐 王新平[2] 许淑梅 刘宏斌[1,2,4] ZHANG An;WANG Wen-an;WANG Jing(First Clinical Medical College,Gansu University of Chinese Medicine,Lanzhou 730000,China;Department of General Surgery,the 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army)

机构地区：[1]甘肃中医药大学第一临床医学院,甘肃兰州730000 [2]中国人民解放军联勤保障部队第940医院普通外科 [3]中国人民解放军联勤保障部队第940医院心血管内科 [4]兰州大学第二临床医学院

出　　处：《腹腔镜外科杂志》2021年第3期191-195,共5页Journal of Laparoscopic Surgery

摘　　要：目的:探讨达芬奇机器人胃癌根治术治疗进展期胃癌的疗效、应激反应及营养状况,以明确达芬奇机器人手术系统相较腹腔镜手术在术中损伤控制、围手术期营养方面的优势。方法:回顾分析2017年6月至2019年6月施行全胃切除术及Roux-en-Y吻合的279例患者的临床资料,其中162例行达芬奇机器人全胃切除术(RATG)及Roux-en-Y吻合(RATG组),117例行腹腔镜全胃切除术(LATG)加Roux-en-Y吻合(LATG组),比较两组患者基本资料、术后应激反应指标及营养状况。术后并发症根据并发症Clavien-Dindo分级系统进行分析。结果:RATG组手术时间长于LATG组[(240.91±22.38)min vs.(230.34±37.39)min,P<0.05],清扫淋巴结数量多于LATG组[(46.05±11.33)vs.(39.52±9.33),P<0.05],术后通气时间早于LATG组[(2.67±0.96)d vs.(2.94±1.09)d,P<0.05],术后住院时间短于LATG组[(9.89±3.70)d vs.(11.66±4.65)d,P<0.05],术后Ⅲ级并发症少于LATG组。RATG组IL-6于术后第1天[(20.65±4.36)pg/dL vs.(26.26±6.99)pg/dL,P<0.05]、第3天[(10.14±1.30)pg/dL vs.(11.34±1.78)pg/dL,P<0.05]低于LATG组,术后第3天C反应蛋白[(15.39±1.45)mg/dL vs.(16.29±1.33)mg/dL,P<0.05]低于LATG组,术后第1天白细胞[(11.41±1.88)×10^(9)/L vs.(12.48±2.10)×10^(9)/L,P<0.05]低于LATG组。在术后短期营养方面,RATG组血清白蛋白第1天[(3.22±0.72)g/dL vs.(2.96±0.53)g/dL,P<0.05]、第3天[(3.14±0.76)g/dL vs.(2.90±0.78)g/dL P<0.05]高于LATG组。第3天营养预后指数[(40.57±3.84)vs.(39.66±2.39),P<0.05]高于LATG组。结论:达芬奇机器人手术系统可有效控制术中损伤,进而改善进展期胃癌患者围手术期营养状况。Objective:To explore the clinical efficacy,stress response and postoperative nutrition status of Da Vinci robot-assisted totally gastrectomy for advanced gastric cancer,in order to clarify the advantage of damage control and perioperative nutrition of Da Vinci robotic surgical system compared with laparoscopic surgery.Methods:Retrospective analysis was made on the clinical data of 279 patients who underwent total gastrectomy for gastric cancer and Roux-en-Y anastomosis from Jun.2017 to Jun.2019.Among them,162 patients who underwent Da Vinci robotic-assisted radical total gastrectomy(RATG)were in RATG group,117 patients who underwent laparoscopic-assisted total gastrectomy(LATG)were divided into LATG group.The basic data,postoperative stress response indexes and nutritional status of the two groups were compared.The postoperative complications were analyzed according to the complication Clavien-Dindo classification system.Results:The operation time of the RATG group was longer than that of the LATG group[(240.91±22.38)min vs.(230.34±37.39)min,P<0.05],the number of lymph node dissection was more than that of the LATG group[(46.05±11.33)vs.(39.52±9.33),P<0.05],the postoperative ventilation time was earlier than that of the LATG group[(2.67±0.96)d vs.(2.94±1.09)d,P<0.05],and the postoperative hospital stay was shorter than that of the LATG group[(9.89±3.70)d vs.(11.66±4.65)d,P<0.05].Postoperative grade Ⅲ complications of the RATG group were less than those of the LATG group.The level of IL-6 in the RATG group was significantly lower than that in the LATG group on the first day[(20.65±4.36)pg/dL vs.(26.26±6.99)pg/dL,P<0.05]and the third day[(10.14±1.30)pg/dL vs.(11.34±1.78)pg/dL,P<0.05]after surgery.In the RATG group,the C-reactive protein was significantly lower than that in the LATG group on the 3rd day after the operation[(15.39±1.45)mg/dL vs.(16.29±1.33)mg/dL,P<0.05],and the white blood cells on the postoperative first day was significantly lower than that in the LATG group[(11.41±1.88)vs.(12.48±

关 键 词：胃肿瘤 胃癌根治术 达芬奇机器人 腹腔镜检查 治疗结果 围手术期营养 

分 类 号：R735.2[医药卫生—肿瘤]