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目的比较完全腹腔镜胃癌根治术与传统腹腔镜辅助胃癌根治术的临床疗效,探讨全腹腔镜下吻合技术在腹腔镜胃癌根治术中的安全性及可行性。方法回顾性分析2013年1月至2014年3月期间我科64例行完全腹腔镜胃癌根治术(全腔镜组)和70例行传统腹腔镜辅助胃癌根治术(腔镜辅助组)患者的临床资料。结果134例手术均获成功,无一例中转开腹。与腔镜辅助组相比,全腔镜组的吻合时间〔(73.8±10.3)min比(72.7±8.9)min,t=0.693,P=0.489〕和清扫淋巴结数〔(32.4±9.7)枚比(33.6±9.6)枚,t=-0.700,P=0.485〕差异均无统计学意义,但术中出血量〔(275.0±66.3)m L比(364.3±75.7)m L,t=-7.419,P=0.000〕明显减少,切口长度〔(3.0±0.8)cm比(7.3±1.7)cm,t=-19.354,P=0.000〕明显减小、进食流质时间〔(4.9±0.8)d比(6.0±0.7)d,t=-8.750,P=0.000〕、肛门排气时间〔(2.8±0.8)d比(3.9±0.8)d,t=-8.388,P=0.000〕、下床活动时间〔(1.3±0.5)d比(3.4±1.2)d,t=-14.118,P=0.000〕、住院时间〔(9.8±1.2)d比(13.0±1.5)d,t=-17.471,P=0.000〕明显缩短,且术后患者的疼痛评分〔术后第1 d:(3.4±0.8)分比(6.2±1.3)分,t=-15.509,P=0.000;术后第3 d:〔(1.7±0.6)分比(4.0±0.8)分,t=-18.799,P=0.000〕明显降低和需要的止痛剂剂量〔(1.7±0.7)支比(4.0±2.1)支,t=-8.912,P=0.000〕明显减少。腔镜辅助组出现吻合口漏1例,出现吻合口狭窄3例,吻合口相关并发症发生率为5.7%(4/70)。全腔镜组均未出现吻合口漏、吻合口狭窄或吻合口出血等吻合口相关并发症。结论完全腹腔镜下吻合技术在腹腔镜胃癌根治术中安全、可行,与小切口辅助吻合相比具有创伤小、出血少、恢复快、住院时间短、疼痛感轻等优势,近期效果显著。
Objective To compare the clinical effects of complete laparoscopic radical gastrectomy and conventional laparoscopic radical gastrectomy for gastric cancer, and to explore the safety and feasibility of laparoscopic radical gastrectomy for laparoscopic gastrectomy. Methods We retrospectively analyzed 64 patients who underwent complete laparoscopic radical gastrectomy for gastric cancer from January 2013 to March 2014 and 70 patients undergoing traditional laparoscopic radical gastrectomy (endoscopic assisted group). clinical information. Results All the 134 cases were successfully performed. No case was converted to laparotomy. Compared with the endoscope-assisted group, the anastomosis time of the total endoscopic group was (73.8±10.3)min (72.7±8.9) min, t=0.693, P=0.489) and the number of lymph nodes cleared (32.4±9.7). (33.6±9.6) pieces, t=-0.700, P=0.485. There was no statistically significant difference, but intraoperative blood loss was (275.0±66.3)m L vs. (364.3±75.7)m L, t=-7.419. P = 0.000 〕 significantly reduced, incision length ((3.0 ± 0.8) cm ratio (7.3 ± 1.7) cm, t = -19.354, P = 0.000) decreased significantly, eating fluid time [(4.9 ± 0.8) d ratio (6.0 ±0.7)d,t=-8.750,P=0.000],anal exhaust time ((2.8±0.8)d vs (3.9±0.8)d,t=-8.388,P=0.000), ambulation time (( 1.3 ± 0.5) d ratio (3.4 ± 1.2) d, t = -14.118, P = 0.000], hospital stay ((9.8 ± 1.2) d ratio (13.0 ± 1.5) d, t = -17.471, P = 0.000) Shortened and postoperative patient pain scores (1st postoperative day: (3.4±0.8) points ratio (6.2±1.3) points, t=-15.509, P=0.000; postoperative 3rd day: [(1.7±0.6) ) Ratio (4.0 ± 0.8) points, t = -18.799, P = 0.000) Significantly decreased and required analgesic dose [(1.7 ± 0.7) branch ratio (4.0 ± 2.1), t = -8.912, P = 0.000 〕obviously decrease. In the endoscope-assisted group, there was one anastomotic leakage and three anastomotic strictures. The incidence of anastomotic complications was 5.7% (4/70). There was no anastomotic complications such as anastomotic leakage, anastomotic stenosis, or anastomotic bleeding in the total endoscopic group. Conclusion Complete laparoscopic anastomosis is safe and feasible in laparoscopic radical gastrectomy for gastric cancer. Compared with small incision-assisted anastomosis, it has the advantages of less trauma, less bleeding, faster recovery, shorter hospital stay, and less pain. The recent results are significant.