3D高清全腹腔镜残胃癌切除术的临床疗效分析

Clinical efficacy of 3D HD total laparoscopic gastrectomy

关键词:  胃肿瘤  残胃癌  3D  全腹腔镜  并发症  疗效

Key words:  gastric neoplasms  gastric stump neoplasms(GSC)  three-dimension(3D)  totally laparoscopy  complications  efficacy

摘要:

探讨因良性疾病而行胃大部切除术后发生的残胃癌患者，应用3D全腹腔镜残胃癌切除术的临床疗效。　方法　收集2015年5月至2018年6月大连医科大学附属第二医院收治的19例行3D高清全腹腔镜残胃癌手术患者资料，所有患者既往因胃良性疾病而行胃大部切除术，本次入院术前均经胃镜和病理活检确诊为胃癌。采用回顾性横断面研究方法，对患者手术及术后恢复情况、病理情况、住院费用等进行统计学分析，并随访其生存及复发情况。　结果　（1）手术情况：19例残胃癌患者中，行3D高清全腹腔镜根治性残胃切除术18例，行3D高清全腹腔镜姑息性残胃切除术1例。19例行3D高清全腹腔镜残胃切除术患者，手术时间为（223.63±53.47）min，术中出血量为（136.32±82.95）mL，淋巴结清扫数目为（26.05±6.84）枚。（2）术后情况：术后离床活动时间（1.39±0.46）d，术后肛门首次排气时间（2.08±0.92）d，术后进流食时间（4.45±2.39）d，拔除引流管时间（9.95±5.28）d，术后住院时间为（13.74±9.69）d。总费用（80271.69±22536.91）元。患者术后出现食管空肠吻合口漏1例，十二指肠残端漏1例，切口感染1例，肺部感染2例，无围手术期死亡。（3）随访情况：对19例行3D高清全腹腔镜残胃切除术患者随访，随访时间3~40个月，中位随访时间17个月；随访期间死亡7例，存活12例。　结论　对于因良性疾病而行胃大部切除术后发生的残胃癌，应用3D全腹腔镜行残胃切除术是安全、有效的。

Abstract:

Objective To investigate the clinical efficacy of three-dimensional (3D) high definition (HD) total laparoscopic gastrectomy for patients with gastric stump cancer after subtotal gastrectomy of benign gastric diseases. Methods From May 2015 to June 2018, 19 patients with gastric stump cancer received 3D HD laparoscopic gastrectomy in the Second Affiliated Hospital of Dalian Medical University. All patients had subtotal gastrectomy for benign gastric diseases. All patients were diagnosed with gastric cancer by gastroscopy and pathological biopsy before admission. A retrospective cross-sectional study was conducted. Postoperative recovery, pathological condition and hospitalization expenses of the patients were analyzed statistically. Results (1) Surgery: Among the 19 patients with gastric stump cancer, 18 underwent 3D HD laparoscopic radical gastrectomy, 1 underwent 3D HD laparoscopic palliative gastrectomy. The operation time was (223.63±53.47) min, the amount of bleeding during operation was (136.32±82.95) mL, and the number of lymph nodes dissected was (26.05±6.84). (2) Postoperative condition: postoperative ambulation time was (1.39±0.46) d, postoperative first flatulence time was (2.08±0.92) d and postoperative feeding time was (4.45±2.39) d. The time of intraperitoneal drainage after operation was (9.95±5.28) d, and the length of postoperative hospitalization was (13.74±9.69) d. The total cost was (80271.69±22536.91) Yuan. Postoperative anastomotic leakage occurred in 1 case, duodenal stump leakage in 1 case, incision infection in 1 case, lung infection in 2 cases, and no perioperative death. (3) Follow-up: 19 patients who underwent 3D HD totally laparoscopic gastrectomy were followed up for 3-40 months with a median of 17 months. During the follow-up, 7 patients died and 12 survived. Conclusion 3D total laparoscopic gastrectomy is safe and effective for gastric stump cancer after subtotal gastrectomy for benign gastric diseases.