完全腹腔镜远端胃癌根治术的临床研究

发布时间：2018-04-01 15:46

本文选题：完全腹腔镜　切入点：远端胃癌　出处：《新乡医学院》2015年硕士论文

【摘要】：背景胃癌是我国发病率最高的恶性肿瘤,而手术治疗是胃癌治愈的首要手段。从腹腔镜技术开始运用于胃癌手术治疗发展至今,腹腔镜辅助下远端胃癌根治术已在各地医院得到了广泛的开展。而随着微创理念的要求和各类腔内缝合器的产生,完全腹腔镜远端胃癌根治术也在国内少数医疗中心开展。但其在国内开展较晚,尚处于探索阶段,所以其能否达到腹腔镜辅助的安全性、可行性及疗效,能否确切的减少创伤、加速术后恢复、改善美容效果等,都值得进一步探究。目的探究完全腹腔镜远端胃癌根治术的安全性、根治性、美容效果及近期疗效。方法本研究选取2013年12月至2015年2月间的70例在我科行远端胃癌D2根治术的患者,随机分为A、B两组。A组32例行TLDG(totally laparoscopic distal gastrectomy),即完全腹腔镜远端胃癌根治术,B组38例行LADG(laparoscopic-assisted distal gastrectomy),即腹腔镜辅助远端胃癌根治术。通过对两组患者间临床资料及术中术后各项指标的对比,探讨的全腹腔镜远端胃癌根治术的安全性和疗效。结果在术中观察指标方面,A组手术时间为(221.5±25.7)min,B组手术时间为(216.2±28.8)min,差异无统计学意义(P=0.423)；A组手术切口长度明显短于B组(4.3±1.2) cm vs (6.2±1.6) cm,差异有统计学意义(P=0.000)；A组术中出血量明显少于B组(115.4±32.7)ml vs(143.8±35.6)ml,差异有统计学意义(P=0.001)；A组淋巴结清扫个数为(21.7±4.5)枚,B组淋巴结清扫个数为(19.6±5.7)枚,两组结果相比差异无统计学意义(P=0.096)；A组肿瘤上切缘长度为(4.7±1.3)cm,B组肿瘤上切缘长度为(4.3±1.1)cm,差异无统计学意义(P=0.168)；A组肿瘤下切缘长度为(3.3±0.9)cm,B组肿瘤下切缘长度为(3.1±1.0)cm,两组结果相比差异无统计学意义(P=0.386)。在术后观察指标方面：A组术后首次排气时间明显短于B组(3.8±1.1)d vs(4.5±1.3)d,差异有统计学意义(P=0.019)；A组术后住院时间明显短于B组(8.6±2.1)d vs(10.4±3.5)d,差异有统计学意义(P=0.013)。而两组患者的出现术后并发症发生率分别为15.6%和18.4%,差异无统计学意义(P0.05)。结论此次研究结果显示完全腹腔镜下远端胃癌根治术有着与腹腔镜辅助远端胃癌根治术相当的手术安全性、根治性及近期疗效。而完全腹腔镜远端胃癌根治术较之腹腔镜辅助远端胃癌根治术具有更短的手术切口,美容效果也更为突出。同时,与腹腔镜辅助远端胃癌根治术相比,完全腹腔镜远端胃癌根治术的手术创伤更小,在术后胃肠功能恢复方面更具优势,更利于患者术后的快速康复。
[Abstract]:Background gastric cancer is the most common malignant tumor in China, and surgical treatment is the most important method for the cure of gastric cancer. Laparoscopic assisted radical resection of distal gastric cancer has been widely carried out in hospitals. However, with the requirement of minimally invasive principle and the emergence of various kinds of endovascular suture devices, Complete laparoscopic distal gastric cancer radical resection is also carried out in a few medical centers in China. However, it is still in the exploratory stage because of its late development in China, so whether it can achieve the safety, feasibility and efficacy of laparoscopy, and whether it can definitely reduce trauma. It is worth further study to accelerate postoperative recovery and improve cosmetic effect. Objective to explore the safety and efficacy of radical laparoscopic distal gastric cancer surgery. Methods from December 2013 to February 2015, 70 patients with distal gastric cancer underwent D2 radical resection in our department. Group A was randomly divided into two groups. Group A (32 cases) were treated with TLDG(totally laparoscopic distal gastrectomyn (group B), and group B (38 cases) with LADG(laparoscopic-assisted distal gastrectomycosis (group B). The clinical data and postoperative indexes were compared between the two groups. Results the operative time of group A was 221.5 卤25.7 min and the operative time of group B was 216.2 卤28.8min. There was no significant difference in the length of incision between group A and group B (P < 0. 423). The amount of intraoperative bleeding in group A was significantly lower than that in group B (115.4 卤32.7)ml 卤35.6ml), and the number of lymph nodes dissected in group A was 21.7 卤4.5) and the number of lymph nodes dissected in group B was 19.6 卤5.7mm. There was no significant difference between the two groups in the length of tumor superior incisor in group A (4.7 卤1.3 cm) and in group B (4.3 卤1.1 cm). There was no significant difference in the length of lower margin of tumor between group A and group A (3.3 卤0.9 cm ~ (-1)), and the length of tumor margin in group B was 3.1 卤1.0 cm ~ (-1) cm ~ (-1). There was no significant difference in postoperative parameters between two groups (P < 0.01). The postoperative first exhaust time in group A was significantly shorter than that in group B (3.8 卤1.1 vs(4.5 卤1.3 d), and the postoperative hospitalization time of group A was significantly shorter than that of group B (8.6 卤2.1 days 卤3.5 days), and the difference was statistically significant (P 0.013). The incidence of postoperative complications in the two groups was 15.6% and 18.4, respectively. There was no significant difference between the two groups (P 0.05). Conclusion the results of this study show that the total laparoscopic radical resection of distal gastric cancer is as safe as laparoscopic assisted radical gastrectomy of distal gastric cancer. Total laparoscopic distal gastric cancer radical resection has shorter incision and more prominent cosmetic effect than laparoscopic assisted distal gastric cancer radical resection. At the same time, compared with laparoscopic assisted distal gastric cancer radical mastectomy, total laparoscopic distal gastric cancer radical resection is more effective than laparoscopic assisted distal gastric cancer radical resection. Complete laparoscopic distal gastric cancer surgery has less trauma, more advantages in the recovery of gastrointestinal function, and is more conducive to the rapid recovery of postoperative patients.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.2

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