达芬奇机器人胃癌根治术临床疗效及对腹腔微转移影响的研究
发布时间：2018-08-02 18:38
【摘要】：研究背景： 胃癌是我国最常见的消化道恶性肿瘤之一，死亡率居恶性肿瘤首位，其治疗手段主要以外科手术为主。传统的手术方式为开腹胃癌手术，自1987腹腔镜胆囊切除手术被成功应用以来，腹腔镜技术因其独特的微创优势，在外科各个领域逐渐得到了广泛的应用。1994年Kitano等首次报道了腹腔镜技术应用于胃癌，经过多年的发展，腹腔镜胃癌根治术因其创伤小、恢复快逐渐成为外科治疗胃癌的主要手段而被人们广泛接受。如今，胃癌微创外科治疗已成为目前研究的热点之一。 随着外科治疗科技的发展，达芬奇机器人手术系统逐渐被引入手术治疗领域。2002年，Hashizume等首次报道了达芬奇机器人手术系统辅助胃癌根治术。与传统的腹腔镜及开腹胃癌手术相比，达芬奇机器人作为一项新型的微创手术方式现今仍处于探索阶段，目前国际国内相关文献报道有限，且多为单纯病例报道，主要阐述达芬奇机器人手术是一种安全、可行的手术方式。但是，达芬奇机器人手术系统是否应在外科治疗胃癌中得到广泛应用，其临床疗效是否肯定,尚缺乏相应的临床对照研究；机器人胃癌手术对患者腹腔微转移与传统腹腔镜及开腹手术相比是否具有不同影响，目前尚未见相关文献报道。 研究目的： 因此，本实验通过收集我中心胃癌患者临床资料，对比同期行达芬奇机器人远端胃癌根治术、腹腔镜及开腹远端胃癌根治术患者临床疗效指标，进行对照分析，比较三种术式的临床疗效，并对患者进行术后随访，评价达芬奇机器人胃癌手术的临床疗效及探讨其在胃癌手术中的应用价值。同时，收集机器人、腹腔镜及开腹胃癌根治术三种手术方式患者手术前后腹腔冲洗液，分析三种不同手术方式患者腹腔冲洗液中癌胚抗原(carcino-embryonic antigen，CEA)及多巴脱羧酶(dopa decarboxylase,DDC)浓度的变化，对其进行比较分析，初步探讨机器人胃癌根治术对腹腔微转移的影响，为机器人胃癌手术的进一步推广应用提供理论和临床依据。 研究方法： 选取我中心2010年3月至2013年7月成功行机器人远端胃癌根治术患者113例，与同期进行的腹腔镜远端胃癌根治术患者279例，开腹远端胃癌根治术患者87例作为研究对象。手术采用气管插管，全身麻醉加硬膜外麻醉，根据肿瘤部位行根治性远端胃大部切除术。所有患者均按照日本第14版胃癌规约行远端胃癌根治及D2淋巴结清扫术。分别对机器人组和腹腔镜组病人手术时间，术中出血量，淋巴结清扫数量，手术近、远端切缘长度，首次排气时间，首次进食时间，术后住院时间，以及并发症发生率等指标进行对照分析，并对三组患者进行术后随访，做生存分析。同时，收集我中心2013年1月至2014年3月收治行机器人胃癌根治术患者42例，以性别、年龄、BMI、肿瘤分期为协变量使用最邻配比法分别配对腹腔镜手术患者和开腹手术患者各42例，分别收集患者手术前后腹腔冲洗液，采用酶联免疫吸附法，，检测其腹腔冲洗液中CEA及DDC浓度变化。采用SPSS18.0统计软件进行统计分析，检测结果以x s描述，计量资料采用t检验、配对t检验及方差分析，计数资料采用χ2检验及非参数检验，生存分析采用Kaplan-Meier法。P0．05为差异有统计学意义。 结果： 一、机器人与腹腔镜及开腹胃癌根治术临床疗效对比 在本研究中发现，与腹腔镜及开腹远端胃癌根治术相比较，机器人组手术时间更长，淋巴结清扫数量更多、更彻底[(30.1±6.1) vs (27.8±7.3) vs(26.9±6.0)，P0.05]，术中出血更少[(113.8±68.4)mL vs(128.4±64.8)mL vs(278.6±178.4)mL，P0.05]。机器人组病人与腹腔镜及开腹组在术后首次排气时间[(3.0±0.9)d vs (3.1±0.9)d vs(4.1±1.1)d]，术后首次进食时间[(3.7±0.9)d vs (3.9±0.8)d vs(4.6±0.8)d]，术后住院时间[(7.6±1.8)d vs (7.7±1.9)d vs(10.3±2.3)d]等方面比较，机器人组与腹腔镜组差异无统计学意义(P0.05)，但明显优于开腹手术组(P0.05)。在围手术期并发症发面，三组病例并发症发生率为机器人4.4%，腹腔镜5.0%，开腹9.2%，机器人与腹腔镜组差异无统计学意义(P0.05)，优于开腹手术组(P＜0.05)。随访机器人组1、2、3年总体生存率分别为91．7％、77．4％和72．9％；腹腔镜组1、2、3年总体生存率分别为91．2％、76．2％和70．4％，开腹组1、2、3年总体生存率分别为89.7%、71.9%、63.9%，三组比较差异无统计学意义(P＞0.05)。 二、机器人、腹腔镜及开腹胃癌根治术对胃癌腹腔微转移的影响 1、三组手术前后腹腔冲洗液中CEA浓度的变化 机器人组、腹腔镜组及开腹组患者术前腹腔冲洗液中CEA的浓度分别为(241.68±188.6)μg/L、(221.32±173.6)μg/L及(257.39±134.9)μg/L，三者之间比较，差异无统计学意义(F=0.491,P0.05)；三组患者术后腹腔冲洗液中CEA的浓度分别为(1262.29±785.4)μg/L、(1171.80±699.1)μg/L及(2996.46±1946.9)μg/L，三组比较差异有统计学意义(P0.05)，两两比较机器人组患者术后腹腔冲洗液中CEA的浓度显著低于开腹组(P0.05),腹腔镜组患者术后腹腔冲洗液中CEA的浓度也同样低于开腹组(P0.05)，机器人组与腹腔镜组比较差异无统计学意义(P0.05)；且同种手术方式术后腹腔冲洗液中CEA的浓度均较术前显著增高(t=-11.053,-11.700,-9.780,P0.05)。 2、三组手术前后腹腔冲洗液中DDC浓度的变化 机器人组、腹腔镜组及开腹组患者术前腹腔冲洗液中DDC的浓度分别为(7.74±4.8)μg/L、(7.19±4.2)μg/L及(7.71±5.8)μg/L，三者之间比较，差异无统计学意义(F=0.161,P0.05)；三组患者术后腹腔冲洗液中DDC的浓度分别为(87.34±55.0)μg/L、(81.00±52.2)μg/L及(146.35±134.5)μg/L，三组比较差异有统计学意义(P0.05)，两两比较机器人组患者术后腹腔冲洗液中DDC的浓度显著低于开腹组(P0.05),腹腔镜组患者术后腹腔冲洗液中DDC的浓度也同样低于开腹组(P0.05)，机器人组与腹腔镜组比较差异无统计学意义(P0.05)；且同种手术方式术后腹腔冲洗液中DDC的浓度均较术前显著增高(t=-10.261,-9.955,-6.969,P0.05)。 结论： 1、达芬奇机器人胃癌根治术与腹腔镜及开腹胃癌根治术相比具有淋巴结清扫数量更多更彻底、术中出血更少等优点，且手术创伤小、术后并发症少，术后恢复快，提示达芬奇机器人胃癌根治手术安全、可行，可以达到与腹腔镜胃癌根治术及开腹胃癌根治术相同甚至更好的手术效果。 2、达芬奇机器人胃癌根治术与腹腔镜胃癌根治术及开腹胃癌根治术相比，其术后随访1,2,3年总体生存率与腹腔镜胃癌根治术及开腹胃癌根治术相比无显著差异，提示机器人胃癌根治术可以达到与腹腔镜及开腹胃癌根治术相当的临床疗效。 3、达芬奇机器人、腹腔镜及开腹胃癌根治术后腹腔冲洗液中CEA及DDC均高于术前，但机器人手术组及腹腔镜手术组CEA及DDC浓度增高程度均显著低于开腹手术组，提示机器人胃癌根治术与腹腔镜胃癌根治术相比不增加胃癌腹腔微转移的可能性，且明显优于开腹手术，值得进一步推广应用。
[Abstract]:Research background:
Gastric cancer is one of the most common malignant tumors in the digestive tract in China. The mortality rate ranks first in the malignant tumor, and the main treatment means mainly by surgery. The traditional surgical method is laparotomy for gastric cancer. Since the 1987 laparoscopic cholecystectomy has been successfully applied, the laparoscope technology has been gradually in the various fields of surgery because of its unique minimally invasive advantages. It is the first time that.1994 Kitano has been widely used to report the application of laparoscopy to gastric cancer. After years of development, laparoscopic radical gastrectomy has been widely accepted by people for its small trauma and rapid recovery. Now, minimally invasive surgery for gastric cancer has become one of the hotspots of current research.
With the development of surgical technology, the Da Vinci robotic surgical system has been gradually introduced into the field of surgical treatment for.2002 years. Hashizume and other reports of the Da Vinci robotic surgical system assisted radical gastrectomy for the first time. Compared with the traditional laparoscopic and open gastric cancer surgery, the Da Vinci machine is a new type of minimally invasive surgery. It is still in the exploration stage. At present, the international and domestic related literature is limited, and most of the case reports are simple cases. It is mainly explained that Da Vinci robot operation is a safe and feasible operation mode. However, whether the Da Vinci robot operation system should be widely used in the surgical treatment of gastric cancer, its clinical efficacy is not appropriate, and it is still short of corresponding. Compared with traditional laparoscopy and laparotomy, there are no relevant literature reports on the effect of robotic gastric cancer surgery on patients with abdominal micrometastasis compared with traditional laparoscopy and laparotomy.
The purpose of the study is:
Therefore, by collecting the clinical data of the gastric cancer patients in my center, comparing the clinical curative effects of the distal gastrectomy of Da Vinci robot, laparoscopy and laparotomy for the radical gastrectomy of gastric cancer, the clinical curative effect of the three kinds of surgical methods was compared, and the patients were followed up to evaluate the hand of the Da Vinci robot. The clinical effect of the operation and its value in the operation of gastric cancer were discussed. At the same time, the peritoneal lavage fluid was collected before and after the operation of three surgical methods, which were operated by robot, laparoscope and open stomach radical gastrectomy, and analyzed the carcino-embryonic antigen (CEA) and dopa decarboxylase (DOPA decarb) in the abdominal irrigating fluid of the patients with different surgical methods. The changes of oxylase, DDC) concentration are compared and analyzed. The effect of radical gastrectomy on peritoneal micrometastasis is preliminarily discussed, which provides a theoretical and clinical basis for the further popularization and application of the operation of robot gastric cancer.
Research methods:
From March 2010 to July 2013, 113 cases of distal radical gastrectomy for gastric cancer were performed in our center. 279 patients with laparoscopic distal gastrectomy and 87 patients with radical resection of distal gastric cancer at the same time were selected as the subjects. The operation was performed by tracheal intubation, general anesthesia and epidural anesthesia. All patients underwent radical gastrectomy. All patients underwent radical resection of the distal gastric carcinoma and D2 lymph node dissection according to the fourteenth version of Japan's gastric cancer protocol. The operation time, the amount of bleeding, the number of lymph node dissection, the operation near, the length of the distal cutting edge, the first air exhausting time, the first feeding time, the time of postoperative hospitalization, and the operation time of the patients in the robot group and the laparoscope group were respectively carried out. The incidence of complications and other indexes were analyzed, and three groups of patients were followed up for survival analysis. At the same time, 42 patients with radical gastrectomy for robotic gastric cancer were collected from January 2013 to March 2014, with sex, age, BMI, and tumor staging as covariate. The abdominal irrigating fluid of the patients before and after operation was collected in 42 cases. The changes of CEA and DDC in the peritoneal lavage fluid were detected by enzyme linked immunosorbent assay. The statistical analysis was carried out by SPSS18.0 statistical software. The results were described with x s, the measurement data were tested with T, t test and variance analysis, and the count data were tested by x 2 test and Non parametric test, survival analysis using Kaplan-Meier method.P0.05, the difference was statistically significant.
Result:
1. Comparison of clinical efficacy between robot assisted laparoscopic surgery and open radical gastrectomy for gastric cancer
In this study, compared with laparoscopy and laparotomy, the robot group had longer operation time, more lymph node dissection, more thorough [(30.1 + 6.1) vs (27.8 + 7.3) vs (26.9 + 6)), P0.05], less bleeding in the operation [113.8 + 68.4) mL vs (128.4 + 64.8) mL vs (278.6 + 178.4) mL, P0.05]. robot group patients and abdominal cavity The first time exhaust time was [(3 + 0.9) d vs (3.1 + 0.9) d vs (4.1 + 1.1) d] after operation, and the first time after the operation [(3.7 + 0.9) d vs (3.9 + 0.8) d vs (4.6 + 0.8) d], and the postoperative hospital stay [(7.6 +]) d vs It was better than the open operation group (P0.05). In the perioperative complications, the incidence of complications in the three groups was robot 4.4%, laparoscopy 5%, laparotomy 9.2%, and there was no significant difference between the robot and the laparoscopy group (P0.05), superior to the laparotomy group (P < 0.05). The overall survival rate of the follow-up machine group was 91.7%, 77.4% and 72.9, respectively. The total survival rate of 1,2,3 years in the laparoscopic group was 91.2%, 76.2% and 70.4% respectively. The overall survival rate of the open group was 89.7%, 71.9%, and 63.9%, respectively, and there was no statistical difference between the three groups (P > 0.05).
Two, the influence of robot, laparoscopic and open radical gastrectomy on peritoneal micrometastasis in gastric cancer.
The changes of CEA concentration in peritoneal lavage fluid before and after operation in 1 and three groups.
The concentration of CEA in the peritoneal lavage fluid of the patients in the robot group, the laparoscopic group and the laparotomy group were (241.68 + 188.6) mu g/L, (221.32 + 173.6) g/L and (257.39 + 134.9) g/L, and the difference was not statistically significant (F=0.491, P0.05), and the concentration of CEA in the three groups was (1262.29 + 785.4) mu g/L (1171.), respectively. 80 + 699.1) mu g/L and (2996.46 + 1946.9) mu g/L, the three groups were statistically significant (P0.05). 22 compared with the robot group, the concentration of CEA in the peritoneal lavage fluid was significantly lower than that in the open group (P0.05). The concentration of CEA in the peritoneal lavage fluid in the laparoscopic group was also lower than that in the laparotomy group (P0.05), and the robot group was compared with the laparoscope group. There was no significant difference between the two groups (P 0.05), and the concentration of CEA in peritoneal lavage fluid increased significantly after operation (t = - 11.053, - 11.700, - 9.780, P 0.05).
The changes of DDC concentration in peritoneal lavage fluid before and after operation in 2 and three groups.
The concentration of DDC in the peritoneal lavage fluid of the patients in the robot group, the laparoscopy group and the laparotomy group were (7.74 + 4.8) mu g/L, (7.19 + 4.2) g/L and (7.71 + 5.8) g/L, and the difference was not statistically significant (F=0.161, P0.05). The concentration of DDC in the three groups of postoperative peritoneal lavage was (87.34 + 55) mu g/L, respectively, (81 + 52.2) g/L and (146.35 + 134.5) mu g/L, the difference between the three groups was statistically significant (P0.05). 22 compared with the robot group, the concentration of DDC in the peritoneal lavage fluid was significantly lower than that of the open group (P0.05). The concentration of DDC in the peritoneal lavage fluid in the laparoscopic group was also lower than that in the open group (P0.05). There was no statistical difference between the robot group and the laparoscope group. Significance (P 0.05), and the concentration of DDC in peritoneal lavage fluid after the same operation was significantly higher than that before operation (t=-10.261, -9.955, -6.969, P 0.05).
Conclusion:
1, Da Vinci robot radical gastrectomy with laparoscopic radical gastrectomy and laparotomy with radical resection of gastric cancer has the advantages of more lymph node dissection, less bleeding, less surgical trauma, less postoperative complications and quick recovery after operation, which suggests that the radical resection of gastric cancer by Da Vinci robot is safe and feasible, and can be achieved with laparoscopic radical gastrectomy for gastric cancer. And open radical gastrectomy is the same or even better.
2, compared with laparoscopic radical gastrectomy, laparoscopic radical gastrectomy and radical gastrectomy for gastric cancer, the overall survival rate of 1,2,3 years after surgery is not significantly different from that of laparoscopic radical gastrectomy and radical gastrectomy for gastric cancer. It suggests that the radical operation of the robot for gastric cancer is comparable to that of laparoscopy and radical gastrectomy for gastric cancer. Curative effect.
3, the CEA and DDC in the peritoneal lavage fluid of the Da Vinci robot, laparoscopy and laparotomy were higher than those before the operation, but the level of CEA and DDC in the robotic operation group and the laparoscopic operation group were significantly lower than those in the laparotomy group. It is superior to open surgery and is worthy of further application.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R735.2;TP242
本文编号：2160347
[Abstract]:Research background:
Gastric cancer is one of the most common malignant tumors in the digestive tract in China. The mortality rate ranks first in the malignant tumor, and the main treatment means mainly by surgery. The traditional surgical method is laparotomy for gastric cancer. Since the 1987 laparoscopic cholecystectomy has been successfully applied, the laparoscope technology has been gradually in the various fields of surgery because of its unique minimally invasive advantages. It is the first time that.1994 Kitano has been widely used to report the application of laparoscopy to gastric cancer. After years of development, laparoscopic radical gastrectomy has been widely accepted by people for its small trauma and rapid recovery. Now, minimally invasive surgery for gastric cancer has become one of the hotspots of current research.
With the development of surgical technology, the Da Vinci robotic surgical system has been gradually introduced into the field of surgical treatment for.2002 years. Hashizume and other reports of the Da Vinci robotic surgical system assisted radical gastrectomy for the first time. Compared with the traditional laparoscopic and open gastric cancer surgery, the Da Vinci machine is a new type of minimally invasive surgery. It is still in the exploration stage. At present, the international and domestic related literature is limited, and most of the case reports are simple cases. It is mainly explained that Da Vinci robot operation is a safe and feasible operation mode. However, whether the Da Vinci robot operation system should be widely used in the surgical treatment of gastric cancer, its clinical efficacy is not appropriate, and it is still short of corresponding. Compared with traditional laparoscopy and laparotomy, there are no relevant literature reports on the effect of robotic gastric cancer surgery on patients with abdominal micrometastasis compared with traditional laparoscopy and laparotomy.
The purpose of the study is:
Therefore, by collecting the clinical data of the gastric cancer patients in my center, comparing the clinical curative effects of the distal gastrectomy of Da Vinci robot, laparoscopy and laparotomy for the radical gastrectomy of gastric cancer, the clinical curative effect of the three kinds of surgical methods was compared, and the patients were followed up to evaluate the hand of the Da Vinci robot. The clinical effect of the operation and its value in the operation of gastric cancer were discussed. At the same time, the peritoneal lavage fluid was collected before and after the operation of three surgical methods, which were operated by robot, laparoscope and open stomach radical gastrectomy, and analyzed the carcino-embryonic antigen (CEA) and dopa decarboxylase (DOPA decarb) in the abdominal irrigating fluid of the patients with different surgical methods. The changes of oxylase, DDC) concentration are compared and analyzed. The effect of radical gastrectomy on peritoneal micrometastasis is preliminarily discussed, which provides a theoretical and clinical basis for the further popularization and application of the operation of robot gastric cancer.
Research methods:
From March 2010 to July 2013, 113 cases of distal radical gastrectomy for gastric cancer were performed in our center. 279 patients with laparoscopic distal gastrectomy and 87 patients with radical resection of distal gastric cancer at the same time were selected as the subjects. The operation was performed by tracheal intubation, general anesthesia and epidural anesthesia. All patients underwent radical gastrectomy. All patients underwent radical resection of the distal gastric carcinoma and D2 lymph node dissection according to the fourteenth version of Japan's gastric cancer protocol. The operation time, the amount of bleeding, the number of lymph node dissection, the operation near, the length of the distal cutting edge, the first air exhausting time, the first feeding time, the time of postoperative hospitalization, and the operation time of the patients in the robot group and the laparoscope group were respectively carried out. The incidence of complications and other indexes were analyzed, and three groups of patients were followed up for survival analysis. At the same time, 42 patients with radical gastrectomy for robotic gastric cancer were collected from January 2013 to March 2014, with sex, age, BMI, and tumor staging as covariate. The abdominal irrigating fluid of the patients before and after operation was collected in 42 cases. The changes of CEA and DDC in the peritoneal lavage fluid were detected by enzyme linked immunosorbent assay. The statistical analysis was carried out by SPSS18.0 statistical software. The results were described with x s, the measurement data were tested with T, t test and variance analysis, and the count data were tested by x 2 test and Non parametric test, survival analysis using Kaplan-Meier method.P0.05, the difference was statistically significant.
Result:
1. Comparison of clinical efficacy between robot assisted laparoscopic surgery and open radical gastrectomy for gastric cancer
In this study, compared with laparoscopy and laparotomy, the robot group had longer operation time, more lymph node dissection, more thorough [(30.1 + 6.1) vs (27.8 + 7.3) vs (26.9 + 6)), P0.05], less bleeding in the operation [113.8 + 68.4) mL vs (128.4 + 64.8) mL vs (278.6 + 178.4) mL, P0.05]. robot group patients and abdominal cavity The first time exhaust time was [(3 + 0.9) d vs (3.1 + 0.9) d vs (4.1 + 1.1) d] after operation, and the first time after the operation [(3.7 + 0.9) d vs (3.9 + 0.8) d vs (4.6 + 0.8) d], and the postoperative hospital stay [(7.6 +]) d vs It was better than the open operation group (P0.05). In the perioperative complications, the incidence of complications in the three groups was robot 4.4%, laparoscopy 5%, laparotomy 9.2%, and there was no significant difference between the robot and the laparoscopy group (P0.05), superior to the laparotomy group (P < 0.05). The overall survival rate of the follow-up machine group was 91.7%, 77.4% and 72.9, respectively. The total survival rate of 1,2,3 years in the laparoscopic group was 91.2%, 76.2% and 70.4% respectively. The overall survival rate of the open group was 89.7%, 71.9%, and 63.9%, respectively, and there was no statistical difference between the three groups (P > 0.05).
Two, the influence of robot, laparoscopic and open radical gastrectomy on peritoneal micrometastasis in gastric cancer.
The changes of CEA concentration in peritoneal lavage fluid before and after operation in 1 and three groups.
The concentration of CEA in the peritoneal lavage fluid of the patients in the robot group, the laparoscopic group and the laparotomy group were (241.68 + 188.6) mu g/L, (221.32 + 173.6) g/L and (257.39 + 134.9) g/L, and the difference was not statistically significant (F=0.491, P0.05), and the concentration of CEA in the three groups was (1262.29 + 785.4) mu g/L (1171.), respectively. 80 + 699.1) mu g/L and (2996.46 + 1946.9) mu g/L, the three groups were statistically significant (P0.05). 22 compared with the robot group, the concentration of CEA in the peritoneal lavage fluid was significantly lower than that in the open group (P0.05). The concentration of CEA in the peritoneal lavage fluid in the laparoscopic group was also lower than that in the laparotomy group (P0.05), and the robot group was compared with the laparoscope group. There was no significant difference between the two groups (P 0.05), and the concentration of CEA in peritoneal lavage fluid increased significantly after operation (t = - 11.053, - 11.700, - 9.780, P 0.05).
The changes of DDC concentration in peritoneal lavage fluid before and after operation in 2 and three groups.
The concentration of DDC in the peritoneal lavage fluid of the patients in the robot group, the laparoscopy group and the laparotomy group were (7.74 + 4.8) mu g/L, (7.19 + 4.2) g/L and (7.71 + 5.8) g/L, and the difference was not statistically significant (F=0.161, P0.05). The concentration of DDC in the three groups of postoperative peritoneal lavage was (87.34 + 55) mu g/L, respectively, (81 + 52.2) g/L and (146.35 + 134.5) mu g/L, the difference between the three groups was statistically significant (P0.05). 22 compared with the robot group, the concentration of DDC in the peritoneal lavage fluid was significantly lower than that of the open group (P0.05). The concentration of DDC in the peritoneal lavage fluid in the laparoscopic group was also lower than that in the open group (P0.05). There was no statistical difference between the robot group and the laparoscope group. Significance (P 0.05), and the concentration of DDC in peritoneal lavage fluid after the same operation was significantly higher than that before operation (t=-10.261, -9.955, -6.969, P 0.05).
Conclusion:
1, Da Vinci robot radical gastrectomy with laparoscopic radical gastrectomy and laparotomy with radical resection of gastric cancer has the advantages of more lymph node dissection, less bleeding, less surgical trauma, less postoperative complications and quick recovery after operation, which suggests that the radical resection of gastric cancer by Da Vinci robot is safe and feasible, and can be achieved with laparoscopic radical gastrectomy for gastric cancer. And open radical gastrectomy is the same or even better.
2, compared with laparoscopic radical gastrectomy, laparoscopic radical gastrectomy and radical gastrectomy for gastric cancer, the overall survival rate of 1,2,3 years after surgery is not significantly different from that of laparoscopic radical gastrectomy and radical gastrectomy for gastric cancer. It suggests that the radical operation of the robot for gastric cancer is comparable to that of laparoscopy and radical gastrectomy for gastric cancer. Curative effect.
3, the CEA and DDC in the peritoneal lavage fluid of the Da Vinci robot, laparoscopy and laparotomy were higher than those before the operation, but the level of CEA and DDC in the robotic operation group and the laparoscopic operation group were significantly lower than those in the laparotomy group. It is superior to open surgery and is worthy of further application.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R735.2;TP242
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