摘要
目的对比单孔+1孔3D腹腔镜手术(SILS+1)与传统多孔3D腹腔镜手术(CLS)对进展期远端胃癌患者的近期疗效差异。方法回顾性分析2021年3月至2022年11月我院胃肠外科收治的245例进展期远端胃癌患者资料,按照手术方式的不同分为CLS组(n=125)和SILS+1组(n=120例),对比分析临床资料及指标包括:基线资料、手术时间、术中失血量及输血量、皮下气肿发生率、中转开腹情况、切除淋巴结总数、切缘阴性率、术后疼痛评分(VAS)、切口美容评分、术后肠内外营养时间、术后住院时间、围术期并发症发生率、总费用等。结果两组患者术前的年龄、性别、体质指数(BMI)、肿瘤术前分期、既往基础病史(高血压、糖尿病、COPD、冠心病、腹部手术史)、肿瘤位置及是否合并幽门梗阻方面等基线指标相比较,差异均无统计学意义(P>0.05)。SILS+1组切口美容评分SCAR更高[(2.10±0.40)分vs.(3.29±0.51)分,P<0.05],术中失血量更少[(94.29±107.65)ml vs.(126.64±104.58)ml,P<0.05],术后胃肠道功能恢复更快[(2.59±0.56)d vs.(2.90±0.50)d,P<0.05]。SILS+1组手术耗时更长[(231.21±40.58)min vs.(203.66±54.78)min],气管插管时间也更长[(273.00±48.16)min vs.(249.22±62.72)min],但是其术中切除淋巴结总数更为彻底,切除数量更多[(28.14±12.02)vs.(24.14±11.53)],差异均有统计学意义(P<0.05)。SILS+1组患者术后第1天、术后第2天、术后第4天VAS评分较CLS组更低,差异有统计学意义(P<0.05)。两组患者肿瘤切缘均为阴性,在术中输血、中转开腹情况、皮下气肿发生率方面差异无统计学意义(P>0.05)。两组患者在术后3天的腹腔引流量、肠内外营养时间、住院时长和住院费用上并无差异(P>0.05)。在术后并发症方面,SILS+1组出现4例深静脉血栓事件、CLS组出现5例,两组中均出现1例全身炎症反应综合征,差异无统计学意义(P>0.05),而SILS+1组肺部感染、腹腔感染、切口感染、吻合口�
Objective To compare recent efficacy of single incision plus one laparoscopic surgery(SILS+1)with conventional laparoscopic surgery(CLS)in patients with advanced distalgastric cancer.Methods From March 2021 to NovembeR2022,data of 245 patients with advanced distalgastric canceRwere retrospectively analyzed,and divided into CLS group(n=125)and SILS+1 group(n=120)according to surgical methods.And clinical data and indexes were compared and analyzed,including baseline data,operative time,intraoperative blood loss and blood transfusion,incidence of subcutaneous emphysema,open conversion,total numbeRof lymph nodes dissection,negative marginrate,postoperative pain score(visual analogue scale,VAS),incision cosmetic score,postoperative parenteral and intestinal nutrition time,postoperative hospitalization time,perioperative complication rate,and total cost.Results There was no statistically significant difference in the baseline indicators of age,gender,body mass index(BMI),preoperative tumoRstage,previous underlying medical history(hypertension,diabetes,COPD,coronary heart disease,history of abdominal surgery),tumoRlocation and whetheRit was combined with pyloric obstruction(P>0.05).The incisional cosmetic scores SCARin SILS+1 group were higher[(2.10±0.40)points vs.(3.29±0.51)points,P<0.05],intraoperative blood loss was less[(94.29±107.65)ml vs.(126.64±104.58)ml,P<0.05],and postoperative recovery of gastrointestinal function was quicker[(2.59±0.56)d vs.(2.90±0.50)d,P<0.05].SILS+1 surgery took longer[(231.21±40.58)min vs.(203.66±54.78)min]and the time of tracheal intubation was longer[(273.00±48.16)min vs.(249.22±62.72)min],but theiRtotal numbeRof intraoperative lymph nodes dissected was more thorough,with a higheRnumbeRof dissected lymph nodes[(28.14±12.02)vs.(24.14±11.53)],all P>0.05.Patients who underwent SILS+1 had loweRVAS scores than CLS on the first,second,and fourth postoperative day,and the difference was statistically significant(P<0.05).TumoRmargins were negative in both groups,and there was no sta
作者
尚晨昊
唐锦
吕其君
魏寿江
朱炜杰
郭鹏
黄玉亭
罗均林
曾瑜智
Shang Chenhao;Tang Jin;Lv Qijun(Department of Gastrointestinal Surgery,Affiliated Hospital of North Sichuan Medical College,Nanchong,Sichuan 637000,China.)
出处
《四川医学》
CAS
2024年第5期480-485,共6页
Sichuan Medical Journal
基金
四川省科技厅第一批省级科技计划项目(编号:2022YFS0168)。
关键词
单孔+1孔
胃癌
腹腔镜
远端胃切除术
近期疗效
single incision plus one port
gastric cancer
laparoscopy
distal gastrectomy
recent efficacy
