腹腔鏡與傳統(tǒng)開腹根治術(shù)治療進展期胃癌對比研究

腹腔鏡與傳統(tǒng)開腹根治術(shù)治療進展期胃癌對比研究

秦占川

(贊皇縣醫(yī)院，河北 贊皇 051230)

摘要：目的對比腹腔鏡與傳統(tǒng)開腹根治術(shù)治療進展期胃癌的臨床效果。方法設行腹腔鏡下根治術(shù)治療且病歷資料完整的胃癌進展期患者40例為治療組，設立同期行傳統(tǒng)開腹根治術(shù)治療進展期胃癌40例為對照組，對比2組手術(shù)切口長度、術(shù)中出血量、手術(shù)時間，術(shù)后胃腸功能恢復、下床、進食、住院時間，以及術(shù)后并發(fā)癥發(fā)生情況。結(jié)果治療組手術(shù)切口長度、術(shù)中出血量、手術(shù)時間均顯著低于對照組(P<0.05)；治療組術(shù)后胃腸功能恢復、下床、進食及住院時間均顯著少于對照組(P<0.05);2組術(shù)后并發(fā)癥發(fā)生率比較無統(tǒng)計學意義(P>0.05)。結(jié)論進展期胃癌患者采用腹腔鏡行胃癌根治術(shù),創(chuàng)傷小,術(shù)后恢復快,不會增加術(shù)后并發(fā)癥發(fā)生風險。

關(guān)鍵詞：胃癌；進展期；腹腔鏡；開腹根治術(shù)

DOI:10.13463/j.cnki.cczyy.2015.06.064

中圖分類號：R273文獻標志碼：A

文章編號：2095-6258(2015)06-1272-03

基金項目：河北省科技成果項目(13010520150066)。

作者簡介：秦占川(1963-)，男，主治醫(yī)師，主要從事消化內(nèi)科疾病研究。

Laparoscope and traditional laparotomy radical resection in treatment of advanced gastric cancer

QIN Zhanchuan

(Zanhuang Hospital of Hebei Province, Zanhuang 051230, Hebei Province, China)

Abstract：ObjectiveTo compare the clinical effect of laparoscope and traditional laparotomy radical resection in the treatment of advanced gastric cancer. MethodsA total of 40 patients with advanced gastric cancer for the laparoscopic radical resection with complete medical records were included in the study and served as the observation group, while 40 cases at the same stage for the traditional laparotomy radical resection were served as the control group. The surgical incision length, intraoperative amount of bleeding, operation time, the time of postoperative gastrointestinal function recovery, out of bed, feeding, and hospitalization, and postoperative complications in the two groups were compared. ResultsThe surgical incision length, intraoperative amount of bleeding, operation time in the observation group were significantly lower than those in the control group (P<0.05). The time of postoperative gastrointestinal function recovery, out of bed, feeding, and hospitalization in the observation group was significantly less than that in the control group (P<0.05). The comparison of the occurrence rate of postoperative complications between the two groups was not statistically significant (P>0.05). ConclusionThe laparoscopic radical resection for the advanced gastric cancer patients has advantages of small trauma and rapid postoperative recovery with no increasement of the risk of postoperative complications, and is an effective regimen for treating the advanced gastric cancer.

Keywords：gastric cancer; advanced; laparoscope; laparotomy radical resection

胃癌是消化系統(tǒng)常見惡性疾病，在世界范圍內(nèi)惡性腫瘤發(fā)病率中居第4位，發(fā)病隱匿，確診時多已進展中晚期，失去了最佳治療時間[1-5]。筆者為探討腹腔鏡胃癌根治術(shù)治療進展期胃癌的優(yōu)勢，回顧分析于我院行腹腔鏡胃癌根治患者的病歷資料，并與同期行傳統(tǒng)開腹胃癌根治術(shù)患者病歷資料進行對比?，F(xiàn)將結(jié)果報道如下。

1資料與方法

1.1一般資料選取2010年1月—2014年1月于我院行腹腔鏡下根治術(shù)治療且病歷資料完整的胃癌進展期患者40例為治療組，其中男32例，女8例，年齡42~83歲，平均年齡(60.2±12.1)歲；設同期行傳統(tǒng)開腹胃癌根治術(shù)治療的進展期胃癌40例為對照組，其中男31例，女9例，年齡41~84歲，平均年齡(61.1±11.2)歲。2組術(shù)前均經(jīng)CT、胃鏡、超聲內(nèi)鏡及組織病理學檢查確認為進展期胃癌,排除腫瘤直徑>10 cm、伴大面積漿膜層受侵、周圍組織廣泛浸潤及淋巴結(jié)轉(zhuǎn)移灶融合等不宜行腹腔鏡手術(shù)患者。1.2治療方法治療組在腹腔鏡下行胃癌根治術(shù)，方法：術(shù)前常規(guī)準備，在深麻醉下完成手術(shù)，患者取頭低腳高體位，在臍下緣取長約1.2 cm弧形切口，置入Trocar (12 mm)，腹腔注入CO2氣體以形成氣腹，置入光源，再于左側(cè)腋前線近肋弓約1.5 cm處分別做約1.2 cm、0.5 cm切口，分別置入12 mm、5 mm Trocar，并置入把持鉗及超聲刀；在其對側(cè)面作0.5 cm×0.5 cm橫行切口，插入Trocar (5 mm) 把持鉗及無損傷腸鉗，術(shù)者站于患者左側(cè)完成胃癌根治術(shù)。對照組患者行傳統(tǒng)開腹胃癌根治，手術(shù)操作嚴格遵照規(guī)定步驟進行。1.3觀察指標對比2組術(shù)中、術(shù)后情況及并發(fā)癥發(fā)生率，術(shù)中包括切口長度、術(shù)中出血量、手術(shù)時間；術(shù)后包括胃腸功能恢復、排氣、活動、進食及住院時間。1.4統(tǒng)計學方法數(shù)據(jù)錄入sAs8.0軟件進行處理，計量資料及計數(shù)資料分別采用t檢驗及χ2檢檢，P<0.05為有統(tǒng)計學意義。

2結(jié)果

2.12組手術(shù)情況比較見表1。

表1　2組手術(shù)情況比較( ± s, n=40)

表1　2組手術(shù)情況比較( ± s, n=40)

組 別切口長度/cm術(shù)中出血量/mL手術(shù)時間/min治療組6.13±0.63#120.22±21.13#250.12±14.21#對照組18.25±1.92 240.45±35.36 186.04±15.38

注：與對照組比較,#P<0.05

2.22組術(shù)后情況比較見表2。

表2　2組術(shù)后情況比較( ± s, n=40)　d

表2　2組術(shù)后情況比較( ± s, n=40)　d

組 別胃腸恢復排氣進全流食進半流食下床活動住院天數(shù)治療組1.97±0.39#2.45±0.32#1.01±0.13#2.01±0.69#2.25±0.46#10.25±1.23#對照組2.24±0.31 3.64±0.28 2.24±0.25 3.64±0.79 3.53±0.89 14.19±1.69

注：與對照組比較，#P<0.05

2.32組術(shù)后并發(fā)癥治療組術(shù)后并發(fā)癥發(fā)生率為17.50%，對照組為22.50%，2組比較，P>0.05。

3小結(jié)

本研究入選患者均采用D2胃癌根治術(shù)[6-13]，取得良好效果。研究[14]表明，腹腔鏡胃癌根治術(shù)患者生活質(zhì)量高于傳統(tǒng)開腹治療，且術(shù)后患者恢復更快。本研究結(jié)果顯示，治療組手術(shù)切口長度、術(shù)中出血量均顯著低于對照組，表明腹腔鏡胃癌根治術(shù)對患者創(chuàng)傷小，但治療組手術(shù)時間顯著長于對照組(P<0.05)，這與腹腔鏡手術(shù)準備工作時間較長，且操作復雜有關(guān)。本研究結(jié)果表明，治療組術(shù)后胃腸功能恢復、排氣、進食流食、進半流食、下床活動及住院天數(shù)顯著低于對照組(P<0.05)，證實腹腔鏡胃癌根治術(shù)對胃癌患者創(chuàng)傷小，術(shù)后胃腸功能恢復快，更利于患者康復。

參考文獻：

[1]JEONG S H, LEE Y J, PARK S T, et al. Risk of recurrence after laparoscopy-assisted radical gastrectomy for gastric cancer performed by a single surgeon[J]. Surgical Endoscopy, 2011, 25(3): 872-878.

[2]YAO Hanhui, HUANG Qiang, ZHU Zhiqiang, et al. Laparoscopy-assisted D2 radical distal gastrectomy for gastric cancer (Billroth II anastomosis)[J]. Chinese Journal of Cancer Research, 2013, 25(4): 451-452.

[3]YU Ge, TANG Bo, YU Peiwu, et al. Systemic and peritoneal inflammatory response after laparoscopic-assisted gastrectomy and the effect of inflammatory cytokines on adhesion of gastric cancer cells to peritoneal mesothelial cells[J]. Surgical Endoscopy, 2010, 24(11): 2860-2870.

[4]PATRITI A, CECCARELLI G, BELLOCHI R, et al. Robot-assisted laparoscopic total and partial gastric resection with D2 lymph node dissection for adenocarcinoma[J]. Surgical Endoscopy, 2008, 22(12): 2753-2760.

[5]BRAUMANN C, JACOBI C A, MENENAKOS C, et al. Robotic-assisted laparoscopic and thoracoscopic surgery with the da Vinci system: a 4-year experience in a single institution[J]. Surgical Laparoscopy Endoscopy & Percutaneous Techniques, 2008, 18(3): 260-266.