腹腔镜技术在胃癌手术中的应用

发布时间：2018-05-02 04:18

本文选题：腹腔镜手术 + 胃癌　；参考：《郑州大学》2016年博士论文

【摘要】：目的研究腹腔镜技术在胃癌手术中的应用及临床疗效。材料与方法提取2012年12月至2015年12月在郑州大学人民医院普外科行腹腔镜胃癌根治术与同期开腹胃癌根治术患者的临床资料,总结腹腔镜技术在胃癌根治术中的的安全性,分析腹腔镜技术在肥胖胃癌患者及残胃癌患者中的应用价值及微创优势。对比研究:1.腹腔镜胃癌根治术与开腹手术患者的临床疗效;2.腹腔镜手术方式和开腹手术方式在肥胖患者中行胃癌根治术的临床疗效。临床疗效分别从手术时间、淋巴结清扫情况、术中出血量、术后进流食时间、术后进固体食时间、排气时间、引流管拔除时间、留置导尿管时间、术后使用镇痛剂的例数、住院总费用、手术切口长度、术后并发症及术后住院时间,术后1-3年生存率等进行对比研究,以确定腹腔镜手术在胃癌患者中的应用价值。结果1.腹腔镜组与开腹组在胃癌根治术中性别、年龄、BMI、标本远近切缘长度、清扫淋巴结的数目、术后病理分期和肿瘤直径等均相似两组比较无统计学意义(P0.05)。术中出血量、术后进流食时间、术后进固体食时间、排气时间、引流管拔除时间、留置导尿管时间、术后使用镇痛剂的例数、切口长度、术后住院天数、术后并发症方面腹腔镜组均优于开腹组;差异均有统计学意义(P0.05)。术后淋巴结清扫数,两组相比无显著性差异(P0.05)。术后住院费用腹腔镜组高于开腹组两组比较差异有统计学意义(P0.05)。2.针对腹腔镜技术在肥胖病人胃癌手术中的应用,腹腔镜组与开腹组病人的性别、年龄、BMI、标本远近切缘长度、清扫淋巴结的数目、术后病理分期和肿瘤直径等均相似,两组病人基线一致统计学比较均无意义(P0.05)。术中出血量,排气时间、切口长度,术后使用镇痛剂的例数、术后进流食时间、术后镇痛药应用次数及住院天数方面,腹腔镜组优于开腹组。腹腔镜组的术后并发症发生率与开腹组相比无明显统计学意义,(P0.05),术后住院总费用腹腔镜组高于开腹组,差异有统计学意义(P0.05)。两组术后3年生存率比较,差异无统计学意义(P0.05)。3.腹腔镜技术在残胃癌手术应用中;手术时间160-310 min,平均(200±55)min;术中出血10-200 m1.平均(110±80)ml。清扫淋巴结数目为12-35枚平均(19±7.0)枚;术后肛门排气时间2-5d,平均(3.1±1.0)d;术后进半流食时间4-10d,平均(5.3±1.6)d;术后下床活动时间1-3d,平均(1.6±0.8)d;术后住院天数7-15 d,平均(8.4±3)d;总住院费用(万元)4.5-9.1万元,平均(5.9±1.3)万元;术后并发症发生率为6.6%(2/30);中位随访18个月,随访率93.4%。随访期间,因肝脏转移死亡2例;因腹膜转移死亡6例,余20例病人一般情况良好。结论1.腹腔镜胃癌根治术治疗胃癌是安全可行的,肿瘤根治性与开腹手术相同,腹腔镜胃癌根治术具有出血少、创伤小、术后恢复快、进食早、住院天数短等优点;腹腔镜胃癌根治术在手术技术上已日渐成熟,中期疗效满意,能够达到和开腹手术相同的疗效,具有一定的微创优势。2.腹腔镜技术在应用于肥胖胃癌病人中具有很好的应用价值,微创优势明显,肥胖并非腹腔镜胃癌根治术的禁忌症。3.腹腔镜在残胃癌手术应用中安全可靠、效果满意,值得临床推广使用。
[Abstract]:Objective to study the application and clinical effect of laparoscopy in gastric cancer surgery. Materials and methods were used to extract the clinical data of laparoscopic radical gastrectomy and radical gastrectomy for gastric cancer at the Department of general surgery, people's Hospital of Zhengzhou University from December 2012 to December 2015, and to summarize the safety of laparoscopic radical gastrectomy for gastric cancer. The application value and minimally invasive advantages of laparoscopy in the patients with gastric cancer and gastric stump. Comparative study on the clinical efficacy of 1. laparoscopic radical gastrectomy and laparotomy; 2. laparoscopic surgery and open surgery in obese patients with radical gastrectomy. The condition of dissection, intraoperative bleeding, postoperative intake of feeding time, postoperative solid food time, exhaust time, drainage time, catheter removal time, the number of postoperative analgesics, total hospitalization expenses, operative incision length, postoperative complications and postoperative hospital stay, and 1-3 year survival rate after operation were compared to determine abdomen. The value of endoscopic surgery in the patients with gastric cancer. Results 1. the sex, age, BMI, the length of the close margin of the specimen, the number of lymph nodes, the postoperative pathological stage and the diameter of the tumor were similar in two groups (P0.05). Solid food time, exhaust time, drainage tube extraction time, indwelling catheter time, postoperative use of analgesics, length of incision, postoperative hospitalization days, postoperative complications were better than laparoscopy group (P0.05). There was no significant difference between the two groups after operation (P0.05). The difference between the two groups of the laparoscopy group was higher than that of the open group (P0.05) the difference was statistically significant (.2.) for the application of the laparoscopy in the operation of the gastric cancer in the obese patients. The sex, age, BMI, the length of the specimen, the number of lymph nodes, the pathological staging and the diameter of the tumor were similar in the two groups. There was no significant difference in baseline Statistics (P0.05). The amount of bleeding, the time of exhaust, the length of the incision, the number of postoperative analgesics, the time of postoperative feeding, the number of postoperative analgesics and the days of hospitalization were better than those in the open group. The incidence of postoperative complications in the laparoscopic group was not statistically significant compared with that in the laparotomy group. P0.05, the total cost of postoperative hospitalization was higher than that in the laparotomy group. The difference was statistically significant (P0.05). There was no significant difference in the 3 year survival rate between the two groups (P0.05).3. laparoscopy in the application of the gastric stump operation; the operation time was 160-310 min, the average (200 + 55) min, and the mean (110 + 80) ml. cleaning lymph nodes in the intraoperative hemorrhage (110 + 80). The number of nodal numbers was 12-35 (19 + 7), and the postoperative anus exhaust time was 2-5d, average (3.1 + 1) d; the time to enter the half feeding time was 4-10d, the average (5.3 + 1.6) d after operation; the ambulation time after operation was 1-3D, average (1.6 + 0.8) d; the hospital days were 7-15 D, average (8.4 + 3) d; the total hospitalization cost (RMB) 4.5-9.1 yuan, average (5.9 +) million yuan; postoperative complications The incidence was 6.6% (2/30), the median follow-up was 18 months, 2 cases died of liver metastasis, 6 cases died of peritoneum metastasis and 20 cases were generally good. Conclusion 1. laparoscopic radical gastrectomy for gastric cancer is safe and feasible, the radical resection of the tumor is the same as that of the open operation, and the laparoscopic radical gastrectomy for gastric cancer is less bleeding. The advantages of small trauma, quick recovery, early feeding and short days of hospitalization, laparoscopic radical gastrectomy has become more and more mature in the surgical technique, and the medium-term effect is satisfactory, and it can achieve the same effect as that of the open operation. It has a certain minimally invasive advantage.2. laparoscopy in applying to fat fat gastric cancer patients with good application value and minimally invasive advantage. Obviously, obesity is not a contraindication for laparoscopic radical gastrectomy..3. laparoscopy is safe and reliable in the operation of gastric stump cancer. It is worthy of clinical application.

【学位授予单位】：郑州大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R735.2

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