摘要
目的 探讨右侧入路应用于腹腔镜胃癌根治术的可行性与安全性.方法 回顾性分析2010年10月至2013年9月间在厦门大学附属第一医院肿瘤外科接受腹腔镜胃癌根治术治疗的178例患者的临床病理资料,其中右侧入路92例（右侧入路组）,左侧入路86例（左侧入路组）.比较两组患者的近期疗效及并发症发生率,并根据体质量指数进行分层分析.结果 对于体质量指数大于或等于24 kg/m^2的患者,右侧入路组（35例）较左侧入路组（31例）手术时间缩短[（227±17） min比（262±23） min],术中出血量减少[（73±9） ml比（84±8）ml],清扫的淋巴结数增多[（35±4）枚比（30±5）枚],术后镇痛药使用时间缩短[（2.1±0.1）d比（2.6±0.4）d],术后下床活动时间提早[（2.2±0.2）d比（2.8±0.6）d],肠功能恢复加快[（3.6±0.3）d比（4.2±0.5）d],差异均有统计学意义（均P＜0.05）;但两组患者术后并发症发生率、术后住院时间及总住院费用的差异则无统计学意义（均P＞0.05）.对于体质量指数小于24 kg/m^2的患者,右侧入路组（57例）与左侧入路组（55例）上述指标的差异均无统计学意义（均P＞0.05）.全组术后随访3～24个月,无一例肿瘤复发或死亡.结论 右侧入路对于腹腔镜胃癌根治术是安全可行的,尤其是对于肥胖患者,右侧入路较左侧入路手术用时短、术中出血少、术后恢复快,且能清扫更多的淋巴结。
Objective To explore the technical feasibility,safety,and short-term clinical efficacy of right-to-lateral approach in laparoscopic-assisted radical gastrectomy.Methods Clinicopathological data of 178 gastric cancer patients undergoing laparoscopic-assisted radical gastrectomy,including 92 patients with right-to-lateral approach （R-LG group） and 86 cases with left-to-lateral approach （L-LG group）,in our department from October 2010 to September 2013 were analyzed retrospectively.Short-term efficacy and complication morbidity were compared between R-LG group and L-LG group according to body mass index（BMI）.Results For those patients with BMI≥24 kg/m^2,the R-LG group （35 cases） had shorter mean operation time,less intraoperative blood loss,shorter painkiller used time than L-LG group（31 cases）[（227±17） min vs.（262±23） min,（73±9） ml vs.（84±8） ml and （2.1±0.1） d vs.（2.6±0.4） d,all P〈0.05].The average time to ambulation and recovery time of peristalsis in the R-LG group were faster than those in L-LG group [（2.2±0.2） d vs.（2.8±0.6） d and （3.6±0.3） d vs.（4.2± 0.5） d,all P〈0.05].The R-LG group had more dissected lymph nodes per patient （35±4） than the L-LG group （30±5） with significant difference （P〈0.05）.There were no significances in postoperative hospital stay,postoperative complication morbidity and hospitalization expenses between R-LG and L-LG group （all P〉0.05）.For those patients with BMI〈24 kg/m^2,there were no significant differences in all above parameters between R-LG group（57 cases） and L-LG group（55 cases）.No mortality and recurrence was observed during follow-up of 3 to 24 months.Conclusion Right-to-lateral approach in laparoscopicassisted radical gastrectomy is a safe and feasible procedure,especially for the obesity patients,which can shorten the operation time,decrease intraoperative blood loss,lead to a faster postoperative recovery and harvest more lymph nodes as compared to L-LG procedure.
出处
《中华胃肠外科杂志》
CAS
CSCD
2014年第11期1115-1120,共6页
Chinese Journal of Gastrointestinal Surgery
基金
卫生部科技研究项目（W2012RQ09）
关键词
胃肿瘤
腹腔镜手术
手术入路
体质量指数
Stomach neoplasms
Laparoscopic procedures
Surgical approachs
Body mass index
