腹腔镜辅助与完全腹腔镜远端胃切除术后恢复的对比  

Comparison of Postoperative Recovery Between Laparoscopic Assisted Distal Gastrectomy and Total Laparoscopic Distal Gastrectomy

作　　者：卢逸箫 曹国栋 李霆[1] Lu Yixiao;Cao Guodong;Li Ting(Department of Gastroenterology,First Affiliated Hospital of Anhui Medical University,Hefei 230032,China)

机构地区：[1]安徽医科大学第一附属医院胃肠外科,合肥230032

出　　处：《中国微创外科杂志》2025年第3期148-152,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：安徽省自然科学基金(2408085QH271)。

摘　　要：目的探讨腹腔镜辅助远端胃切除术(laparoscopic assisted distal gastrectomy,LADG)和完全腹腔镜远端胃切除术(total laparoscopic distal gastrectomy,TLDG)治疗胃癌术后恢复的差异。方法回顾性分析2019年5月~2024年4月99例因胃癌行腹腔镜远端胃切除术的临床资料,根据患者意愿选择行TLDG 49例,LADG 50例。比较2组手术时间、术中出血量、淋巴结清扫数和转移情况、术后止痛药使用次数、排气时间、下床时间、术后住院时间、生活自理能力评分(Barthel指数)、总蛋白、白蛋白及白细胞计数,以及术后并发症包括吻合口漏、吻合口梗阻、胃瘫、乳糜漏、腹腔感染、切口感染、呼吸系统感染等。结果与LADG相比,TLDG术后使用止痛药次数少(中位数0次vs.4次,Z=-5.810,P<0.001),术后4天生活自理能力评分高(中位数50.0分vs.40.0分,Z=-3.232,P=0.001),2组手术时间、术中出血量、获得淋巴结数、淋巴结转移、排气时间、下床时间、术后住院时间、术后并发症、术后总蛋白、白蛋白及白细胞计数差异无显著性(P>0.05)。结论LADG与TLDG在手术效率、安全性上相当,但TLDG术后疼痛轻,术后生活自理能力较好,可能在术后恢复上存在优势。Objective To explore the differences in postoperative recovery between laparoscopic assisted distal gastrectomy(LADG)and total laparoscopic distal gastrectomy(TLDG)for gastric cancer.Methods A retrospective analysis was conducted on clinical data of 99 patients who underwent laparoscopic distal gastrectomy for gastric cancer from May 2019 to April 2024.According to patient preference,49 patients underwent TLDG and 50 patients underwent LADG.The two groups were compared regarding operation duration,intraoperative blood loss,lymph node dissection and metastasis,frequency of postoperative analgesic use,time to gas exhaustion,time to ambulation,postoperative hospital stay,self-care ability score(Barthel Index),total protein,albumin,and white blood cell count,as well as postoperative complications including anastomotic leakage,anastomotic obstruction,gastroparesis,chylous leakage,abdominal infection,incision infection,respiratory system infection and so on.Results Compared with LADG,TLDG resulted in fewer frequency of postoperative analgesic use(median,0 vs.4 times,Z=-5.810,P<0.001)and higher self-care ability scores(median,50.0 points vs.40.0 points,Z=-3.232,P=0.001)after surgery.There were no significant differences in operation duration,intraoperative blood loss,number of lymph nodes obtained,lymph node metastasis,time to gas exhaustion,time to ambulation,postoperative hospital stay,postoperative complications,postoperative total protein,albumin,and white blood cell count between the two groups(P>0.05).Conclusion LADG and TLDG are comparable in surgical efficiency and safety,but TLDG results in less postoperative pain and better self-care ability after surgery,potentially offering advantages in postoperative recovery.

关 键 词：胃癌 腹腔镜辅助远端胃切除术 完全腹腔镜远端胃切除术 

分 类 号：R73[医药卫生—肿瘤]