3D全腹腔镜根治性全胃切除术45例疗效分析

Treatment experience of three-dimensional laparoscopic total gastrectomy in 45 patients

关键词:  全腹腔镜  3D  全胃切除  胃癌

Key words:  totally laparoscopic  three-dimensional laparoscopy  total gastrectomy  gastric cancer

摘要:

目的　探讨3D全腹腔镜技术在根治性全胃切除术中的安全性及可行性。方法　回顾性分析2016年1月至2017年10月在大连医科大学附属第二医院胃肠外科接受3D全腹腔镜根治性全胃切除术45例患者的临床资料，对患者手术情况、术后情况、病理、住院费用等进行统计学分析。结果　45例患者均顺利进行3D全腹腔镜根治性全胃切除术，无中转开腹及围手术期死亡病例，平均手术时间为（218.22±33.30）min，平均出血量为（117.06±71.33）mL，术后首次进流食时间为（3.33±1.47）d，平均清扫淋巴结（36.48±17.49）个，平均拔出腹腔引流管时间为（10.26±6.72）d，术后住院时间（11.80±8.29）d，总住院费用（83370.35±15490.54）元。共有8例（17.8%）患者出现术后并发症：4例食管空肠吻合口漏、2例肺炎、1例重症胰腺炎、1例切口感染，吻合口漏患者行空肠营养管置入及对症治疗后好转、余并发症患者均经对症治疗后好转。结论　3D全腹腔镜根治性全胃切除术安全、可行，创伤小，患者术后恢复快，近期疗效较好。

Abstract:

Objective To investigate the security and feasibility of three-dimensional laparoscopy for radical total gastrectomy. Methods Clinical data of 45 gastric cancer patients, who underwent three-dimensional laparoscopic total gastrectomy from January 2016 to October 2017 in the Department of Gastrointestinal Surgery of the Second Affiliated Hospital of Dalian Medical University, were retrospectively reviewed. The clinical data including operative situations, postoperative situations, pathology results, hospitalization costs, and perioperative period were analyzed statistically. Results All surgeries were performed successfully. There was neither conversion to open surgery nor perioperative death in the perioperative period in all 45 cases. In this study, the median operative time was (218.22±33.30) min, the blood loss（117.06±71.33）mL, the time to initiate oral intake（3.33±1.47）days, the mean lymph node harvest （36.48±17.49）, the time for indwelling catheter（10.26±6.72）days, the length of postoperative hospital stay（11.80±8.29） days, the hospitalization expenses （83370.35±15490.54）yuan. In our study, only 8 patients (17.8%) suffered from postoperative complications. Anastomotic leakage occurred in 4 patients, pulmonary infection in 2 patients, severe pancreatitis in 1 patient, infection of incision in 1 patient. All of the postoperative complications got well with symptomatic treatments. Conclusions Three-dimensional laparoscopic total gastrectomy for gastric cancer may be performed safely and effectively, with less trauma、enhanced recovery and better short-term outcomes.