摘要
目的探讨全腹腔镜下三角吻合联合经自然腔道取标本(NOSES)用于近端胃癌根治术的效果。方法选取安徽医科大学第二附属医院2019年10月至2020年10月收治的62例近端胃癌患者,按照治疗方法的不同分为研究组与对照组,各31例。研究组行近端胃部分切除腹腔镜下三角吻合消化道重建联合NOSES治疗,对照组行食管残胃吻合术联合经腹部切口取标本治疗。比较两组的手术效果、手术前后炎症反应及免疫功能指标,以及并发症发生情况。结果两组患者的性别、年龄、体质指数(BMI)、美国东部肿瘤协作组(ECOG)评分、肿瘤直径、美国麻醉医师协会(ASA)分级及病理分期比较差异无统计学意义(P>0.05)。研究组的手术时间、吻合时间、淋巴结清扫数大于对照组,术中出血量、术后首次排气时间、流质饮食时间、术后下床时间小于对照组,差异有统计学意义(P<0.05),两组术后住院时间比较差异无统计学意义(P>0.05)。两组手术前后炎症反应指标[白细胞计数(WBC)、C反应蛋白(CRP)]及免疫功能指标[CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)]比较差异无统计学意义(P>0.05)。两组术后并发症发生率比较差异无统计学意义(19.4%vs. 25.8%,P>0.05)。随访6个月,两组均无肿瘤复发、转移及死亡患者。结论近端胃癌患者采用全腹腔镜下三角吻合消化道重建联合NOSES治疗比食管残胃吻合术联合经腹部切口取标本治疗的效果更优,术后恢复更快,安全可靠。
Objective To explore the effect of total laparoscopic triangular anastomosis combined with specimen collection through natural cavity for radical resection of proximal gastric cancer. Methods A total of 62 patients with proximal gastric cancer who were diagnosed and treated in our hospital from October 2019 to October 2020 were divided into observation group and control group, 31 cases in each group. The observation group underwent partial proximal gastrectomy and laparoscopic triangular anastomosis to reconstruct the digestive tract, and specimens were taken through the natural cavity(NOSES). The control group underwent esophageal remnant gastric anastomosis and specimens taken through abdominal incisions, the surgical effects of the two groups were compared. Results There were no significant differences in gender, age, body mass index(BMI), ECOG score, tumor diameter, American Society of Anesthesiologists(ASA) grade and pathological stage between two groups(P>0.05). The operative time, anastomosis time and number of lymph nodes dissection were longer than those in the control group, while the amount of intraoperative blood loss, the first postoperative exhaust time, the time of liquid diet and the postoperative time out of bed were less than those in the control group, the differences were statistically significant(P<0.05), while the postoperative hospitalization time between the two groups had no statistical significance(P>0.05). There were no significant differences in inflammatory response(WBC, CRP) and immune function(CD3^(+), CD4^(+), CD8^(+), CD4^(+)/CD8^(+)) between the two groups before and after operation(P>0.05). There was no significant difference in the incidence of postoperative complications between two groups(19.4% vs. 25.8%, P>0.05). After 6 months of follow-up, there were no tumor recurrence, metastasis or death in two groups. Conclusions In patients with proximal gastric cancer, the total laparoscopic triangular anastomosis of digestive tract reconstruction combined with natural cavitary tract
作者
黄洋
周连帮
邹媛远
熊奇如
刘志宁
HUANG Yang;ZHOU Lianbang;ZOU Yuanyuan;XIONG Qiru;LIU Zhining(Department of General Surgery,the Second Affiliated Hospital of Anhui Medical University,Hefei 230601,China;Department of Hepatobiliary Surgery,the Second Affiliated Hospital of Anhui Medical University,Hefei 230601,China)
出处
《中国肿瘤外科杂志》
CAS
2021年第4期367-371,共5页
Chinese Journal of Surgical Oncology
基金
安徽医科大学2020年度校科研基金立项资助项目(2020xkj204)。
关键词
近端胃癌
全腹腔镜下三角吻合消化道重建术
经自然腔道取标本术
Proximal gastric cancer
Total laparoscopic triangular anastomosis digestive tract reconstruction
Specimen collection through natural cavity
