加速康复外科下完全腹腔镜、腹腔镜辅助与开腹根治性全胃切除术的疗效及安全性分析  

The efficacy and safety analysis of totally laparoscopic,laparoscopic-assisted,and open total gastrectomy in enhanced recovery after surgery

作　　者：卫江鹏 柳金强 杨西胜 李世森 余鹏飞 李晓华 郭欣 季刚 WEI Jiangpeng;LIU Jinqiang;YANG Xisheng(Department of Gastrointestinal Surgery,the First Affiliated Hospital,Air Force Medical University,Xi'an 710032,China)

机构地区：[1]空军军医大学第一附属医院胃肠外科,陕西西安710032

出　　处：《腹腔镜外科杂志》2024年第1期10-17,共8页Journal of Laparoscopic Surgery

基　　金：国家自然科学基金青年项目(82100680);陕西省胃癌诊疗的探索与创新团队(2021TD-43);陕西省青年科技新星培育项目(2021KJXX-25);陕西省自然科学基金项目(2023-YBSF-481)。

摘　　要：目的:比较加速康复外科下完全腹腔镜、腹腔镜辅助与开腹根治性全胃切除术的安全性及长期有效性。方法:回顾性收集2017年1月至2021年12月为胃癌患者行完全腹腔镜、腹腔镜辅助及开放根治性全胃切除术的临床资料。结果:共纳入1 447例患者,男1 184例(81.82%),女263例(18.18%);平均(60.7±9.7)岁。其中完全腹腔镜组194例,腹腔镜辅助组249例,开腹组1 004例。3组患者性别、年龄、体质指数等基线资料差异无统计学意义(P>0.05)。完全腹腔镜组、腹腔镜辅助组、开腹组出血量差异有统计学意义[(102.4±9.5)mL vs.(136.8±9)mL vs.(171.2±5.4)mL,P<0.001]。腹腔镜辅助组与开腹组住院时间差异无统计学意义[(7.3±0.2)d vs.(7.4±0.1)d],长于完全腹腔镜组[(6.6±0.2)d],差异有统计学意义(P=0.043)。完全腹腔镜组与腹腔镜辅助组手术费用高于开腹组,差异有统计学意义[(84 193.8±951.7)元vs.(84 444.8±1 343.2)元vs.(76 849.6±728.3)元,P<0.001]。完全腹腔镜组清扫淋巴结总数多于腹腔镜辅助组与开腹组[(30.5±0.6)枚vs.(28.2±0.4)枚vs.(25.9±0.3)枚,P=0.011],阳性淋巴结数量多于其他两组(P=0.002)。术后发生并发症78例(5.4%),Clavien-Dindo分级Ⅰ~Ⅱ级11例(0.8%),Ⅲ级32例(2.2%),Ⅳ级4例(0.3%),Ⅴ级(病死)7例(0.5%),完全腹腔镜组、腹腔镜辅助组与开腹组术后并发症总发生率分别为5.2%(10/194)、4.0%(10/249)与5.8%(58/1 004),差异无统计学意义(P=0.200)。生存分析显示,开腹胃癌手术患者总体生存期、无病生存期更短,多因素Logistic回归分析显示年龄大于60周岁、开腹手术、术后并发症、T分期、N分期是影响根治性全胃切除术后患者生存的独立危险因素。结论:完全腹腔镜、腹腔镜辅助与开腹根治性全胃切除术的安全性一致,腹腔镜手术可能利于改善患者总体生存情况。Objective:To compare the safety and long-term efficacy of totally laparoscopic total gastrectomy(TLTG),laparoscopic-assisted total gastrectomy(LATG),and open total gastrectomy(OTG)in enhanced recovery after surgery.Methods:The clinical data of patients who underwent TLTG,LATG and OTG for gastric cancer from Jan.2017 to Dec.2021 were retrospectively collected.Results:A total of 1447 patients were enrolled,including 1184 males(81.82%)and 263 females(18.18%)with an average age of(60.7±9.7)years.There were 194 cases in the TLTG group,249 cases in the LATG group,and 1004 cases in the OTG group.There was no significant difference in gender,age,body mass index,and other baseline data among the three groups(P>0.05).The amount of blood loss in the TLTG group was the least,followed by the LATG group,which was smaller than the OTG group[(102.4±9.5)mL vs.(136.8±9)mL vs.(171.2±5.4)mL],and the difference was statistically significant(P<0.001).The hospital stay in the LATG group and the OTG group[(7.3±0.2)d vs.(7.4±0.1)d]was longer than that in the TLTG group[(6.6±0.2)d],and the difference was statistically significant(P=0.043).The cost of surgery in the TLTG group and the LATG group was significantly higher than that of the OTG group[(84193.8±951.7)yuan vs.(84444.8±1343.2)yuan vs.(76849.6±728.3)yuan,P<0.001].The number of dissected lymph nodes in the TLTG group was more than that in the LATG group and the OTG group[(30.5±0.6)vs.(28.2±0.4)vs.(25.9±0.3),P=0.011].The number of positive lymph nodes in the TLTG group was more than the other two groups with a significant difference(P=0.002).There were 78 cases of postoperative complications(5.4%),including 11 cases in gradesⅠandⅡ(0.8%),32 cases in gradeⅢ(2.2%),4 cases in gradeⅣ(0.3%),and 7 cases in gradeⅤ(case fatality rate 0.5%)according to Clavien-Dindo classification.The total incidence of postoperative complications in the TLTG group,LATG group,and OTG group was 5.2%(10/194),4.0%(10/249),and 5.8%(58/1004),respectively,and there was no significant differenc

关 键 词：胃肿瘤 胃癌根治术 腹腔镜检查 剖腹术 并发症 预后 

分 类 号：R735.2[医药卫生—肿瘤]