腹腔镜辅助胃癌D2根治术临床研究

Background Laparoscopic assisted radical gastrectomy is gaining acceptance for treating early gastric cancer. However, few reports concerning the effectiveness of patients who have undergone laparoscopic assisted D2 distal gastrectomy (LADG) for advanced gastric cancer or data comparing the results to those obtained after open distal gastrectomy (ODG) are yet available. The aim of this study is to evaluate the method, feasibility and clinical result of laparoscopic assisted D2 radical distal gastrectomy for advanced gastric cancer. Methods A retrospectively study was performed comparing LADG and ODG for advanced gastric cancer. 78 patients who underwent LADG were compared to 90 patients who underwent ODG in terms of pathologic findings, operative outcome, complications. Results There was no conversion to open surgery in LADG group and no postoperative mortality in all patients. There were no significant difference between LADG and ODG in operative time (245±35 vs 220±20 min), complication rate (7.7% vs 10.0%), and number of lymph nodes (23.5±6 vs 21.0±7.5), while the blood loss was less after LADG (110±25 vs 196±30 mL, P＜0.05). The time of postoperative flatus and postoperative hospital stay was shorter after LADG (73±8.5 vs 102±10.5h, and 8.6±1.2 vs 12.1±2.5 d, P＜0.05, respectively). Conclusion Laparoscopic assisted D2 radical distal gastrectomy for advanced gastric cancer is feasible, safe, and minimally invasive.     

腹腔镜与开腹远端胃癌根治术术后近期疗效比较

目的 探讨腹腔镜远端胃癌根治术术后近期疗效.方法 2008年1月至2010年10月,对我院29例胃窦部及胃体下1/2的胃癌患者行腹腔镜远端胃癌根治术,比较腹腔镜与传统开腹远端胃癌手术术后近期疗效.结果 28例成功实行LADG术,1例行剖腹探查.LADG组手术时间(253.1±32.6)min,ODG组(179.4±39.5)min;LADG组术中出血量(268.5±101.4)ml,ODG组(415.9±176.1)ml;LADG组患者术后首次排气时间为(2.1±0.6)d,ODG组为(3.5±0.4)d;LADG组患者切口长度为(5.6±1.6)cm,ODG组为(11.4±1.8)cm;LADG患者总住院天数为(10.6 4±2.4)d,ODG组为(12.1±2.9)d;IADG组所检测出淋巴结数量为(34.5±5.2)枚,ODG组为(36.8 ±6.1)枚.结论 腹腔镜远端胃癌根治术安全可行,近期具有小切口、出血少、术后疼痛轻、胃肠功能恢复快、住院天数少等优点.

Abstract：

Objective To compare the short-term efficacy of laparoscopic-assisted verus open distal gastrectomy for gastric cancer. Methods The data of 29 patients with distal gastric cancer from January 2008 to October 2010 were analyzed. Results Twenty-eight underwent laparoscopic-assisted distal gastrectomy while 1 was switched to open surgery. The operative duration was (253. 1 ± 32. 6) min and the blood loss volume (268.5 ± 101.4) ml. The postoperative recovery time of gastrointestinal peristalsis was (2. 1 ± 0. 6) d. The length of incision was (5.6 ±1.6) cm, the hospital stay duration (10. 6 ±2. 4) d and the number of dissected lymph nodes (34. 5 ± 5. 2 ). Conclusion Laparoscopic-assisted distal gastrectomy for gastric cancer is both safe and feasible. And it offers many advantages of minimal invasion, less pain and shorter hospital stay.     

A matched cohort study of laparoscopy-assisted and open total gastrectomy for advanced proximal gastric cancer without serosa invasion

Background Little is known about the feasibility and safety of laparoscopy-assisted total gastrectomy （LATG） with extended lymphadenectomy in patients with advanced gastric cancer （AGC）.This study compared the technical feasibility,safety,and oncologic efficacy of LATG with open total gastrectomy （OTG） for AGC without serosa invasion.Methods From January 2009 to December 2011,235 patients underwent LATG and 153 patients underwent OTG for AGC without serosa invasion.Age,gender,and depth of invasion （pT2 and pT3） were matched by propensity scoring,and 116 patients （58 LATG and 58 OTG） were selected for analysis.Their clinicopathologic characteristics,postoperative outcomes,and survival were compared.Results There was no significant difference in clinicopathologic characteristics between the two propensity-matched groups.Median number of lymph nodes per patient was 29,and the mean number of retrieved lymph nodes was similar in the LATG and OTG groups （30.8±10.2 vs.29.0±8.3）.Peri-operative characteristics,operation time,number of transfused units per patient,and time to resumption of activities were similar in the two groups; while blood loss,times to first flatus and resumption of soft diet,and post-operative stay were significantly lower in the LATG group （P ＜0.05,respectively）.Rates of post-operative complications （12.1％ vs.15.5％） and postoperative mortality （0％ vs.1.7％）,as well as cumulative survival rates,were similar.Conclusions LATG with D2 lymphadenectomy is a safe and feasible procedure for AGC patients without serosa invasion.ProsPective.multicenter,randomized trials are needed to confirm the efficacy of LATG in this patient population.     

Prognostic impact of splenectomy on advanced proximal gastric cancer with No. 10 lymph node metastasis

Background This study evaluated the prognostic impact of D2 lymphadenectomy combined with splenectomy in patients with advanced proximal gastric cancer and lymph node metastasis at the splenic hilum （No. 10 lymph nodes）. Methods The clinical records of 216 patients with advanced proximal gastric cancer and No. 10 lymph node metastasis who underwent D2 curative resection were retrospectively analyzed. Seventy-three patients underwent simultaneous splenectomy （splenectomy group）, while 143 patients did not （spleen-preserving group）. Five-year survival rates, mean numbers of dissected No. 10 lymph nodes and metastatic No. 10 lymph nodes, and operative morbidity and mortality were calculated and compared between the two groups. Potential prognostic factors were evaluated by univariate and multivariate analysis.
Results The 5-year survival rate was 30.0% for the splenectomy group and 19.7% for the spleen-preserving group （χ^2=14.73, P 〈0.05）. The mean numbers of dissected No. 10 lymph nodes and metastatic No. 10 lymph nodes in the splenectomy group were significantly greater than in the spleen-preserving group （P 〈0.05）. Multivariate analysis revealed that the depth of invasion, splenectomy, and type of gastrectomy were independent prognostic factors. The survival rate for T3 patients with and without splenectomy was 38.7% and 18.9%, respectively （χ^2 =15.03, P 〈0.05）. For patients undergoing total gastrectomy, survival rates were 33.4% and 20.7%, respectively （χ^2 =13.63, P〈0.05）. Operative morbidity and mortality in splenectomy group was 24.7% and 4.1%, respectively, and in the spleen-preserving group was 17.5% and 3.5%, respectively. The differences were not statistically significant （P 〉0.05）. Conclusions Splenectomy is beneficial for No. 10 lymph node dissection in patients with advanced proximal gastric cancer. To improve patient prognosis, total gastrectomy with splenectomy is recommended for patients with T3 proximal gastric cancer who have No. 10 lymph node metastasis.     

Are there any disbenefits to patients in choosing laparoscopic gastrectomy by an expert in open gastrectomy？ Aspects of surgical outcome and radicality of lymphadenectomy

Background There may be concerns over disbenefits to patients who have chosen to undergo laparoscopic gastrectomy by experts in open gastrectomy, considering the disparity between the level of proficiency in open gastrectomy, at which they are already experts, and that in laparoscopic gastrectomy, at which they are beginners. The aim of this study was to compare surgical radicality and outcomes between laparoscopic gastrectomy and open gastrectomy during the learning period of laparoscopic gastrectomy for a senior surgeon who was already an expert in open gastrectomy. Methods Data of short-term surgical outcomes were obtained from patients following laparoscopy assisted distal gastrectomy （LADG） by a surgeon. The initial and following 30 experiences were grouped into LADG-I and LADG-II, respectively. Patients who underwent open distal subtotal gastrectomy （ODSG） and yet could have been candidates for LADG were grouped into ODSG. Known indicators of proficiency levels and the postoperative hospital course were compared. The consequences of extended lymphadenectomy, and the radicality of surgery by completing D2 lymphadenectomy were analyzed. Results The LADG group revealed longer operation time and less bleeding compared to the ODSG group （P 〈0.001）. The number of retrieved lymph nodes and the rate of complications were not significantly different. In the LADG-I group, the DI＋：D2 ratio was 4：1, showing significant differences from those in the LADG-II （0.36：1） and ODSG （0.16：1） groups （P 〈0.001）. The surgeon was able to complete D2 lymphadenectomy during LADG without significant change in the amount of bleeding and the rate of complications, but with a longer operation time （P=0.009）. The number of lymph nodes from the 12a station was not significantly different between the LADG and ODSG groups with D2 lymphadenectomy. Conclusions The surgical outcomes were comparable between LADG and ODSG even during the learning period of LADG, and the equivalence of radicality in lymphadenectomy was soon achieved. As long as the surgeon can accept a long operation time, an expert in open gastrectomy should not refrain from performing laparoscopic gastrectomy in well selected patients because of concerns about disbenefits to patients from choosing laparoscopic gastrectomy over open gastrectomy.     

EFFECTS OF ENTERAL AND PARENTERAL NUTRITION ON GASTROENTERIC HORMONES AND GASTRIC MOTILITY AFTER SUBTOTAL GASTRECTOMY

Objective To investigate the effects of enteral nutrition （EN） and parenteral nutrition （PN） on gastric motility and gastroentefic hormones after subtotal gastrectomy. Methods Forty-one patients underwent gastrectomy were randomly divided into EN group （n=20） and PN group （n=21 ）. From the first postoperative day to the seventh day, patients received either EN （EN group） or PN （PN group） with isocalofic （84.9kJ·kg^-1·d^-1） and isonitrogenous （0.11g·kg^-1·d^-1） intake. Serum gastrin （GAS）, plasma mofilin （MTL）, and plasma cholecystokinin （CCK） were measured on preoperative day, the first and seventh postoperative day. Electrogastrography （EGG） was measured on preoperative day and the seventh postoperative day. Results Compared with preoperafion, blood GAS, MTL, and CCK levels of 41 patients decreased significantly on the first day after subtotal gastrectomy （ P 〈 0. 001 ）, but returned to the preoperative levels one week later. EGG after gastrectomy showed that gastric basal electrical rhythm was significantly restrained （ P 〈 0. 001 ）. On the seventh day after subtotal gastrectomy, plasma MTL and CCK levels in EN group were higher than those in PN group （ P 〈 0.05 ）. There was no difference in GAS level between two groups. EGG in EN group was better than that in PN group postoper- atively. Conclusions The levels of gastroentefitic hormones and the gastric motility decrease significantly after subtotal gastrectomy. In contrast with PN, EN can accelerate the recovery of MTL, CCK, and gastric motility after subtotal gastrectomy.     

EARLY AND LATE RESULTS OF TOTAL GASTRECTOMY IN TREATMENT OF ADVANCED ADENOCARCINOMA OF THE CARDIA

Sixty-six patients with advanced adenocarcinoma of the cardia underwent total gastrectomybetween 1978 and 1986.The operative morbidity rate was 7.5% and the hospital mortalityrate (1 month) was 1.5%.The postoperative 1,3,4,and 5 year survival rates were 69%.50.7%,20% and 13.8% respectively.The quality of life after surgery was improved.Patho-logical type,lymph node metastasis,completeness of resectionand postoperative chemotherapywere the main factors influencing postoperative survival time.Indications for total gastrec-tomy and the advantages of transthoracic total gastrectomy are discussed.     

腹腔镜下子宫颈癌根治术与经腹手术的对比研究

Objective Compare the application value of total laparoscopic radical hysterectomy to that of abdominal radical hysterectomy. Methods This study selected patients who underwent radical hysterectomy for cervical cancer in our hospital during the period from February 2014 to January 2016. Patients undergoing total laparoscopic radical hysterectomy was assigned to TLRH group(19 cases), while thoese who underwent abdominal radical hysterectomy was assigned to ARH group(9 cases). We collected general clinical characteristics of these patients, intraoperative and postoperative conditions, and postoperative complications. Results TLRH group was significant different statistically in operative bleeding, resection of parametrium and time of anal aerofluxus than ARH group(P＜0.05). But there was no difference in the operation time, removal of the number of lymph nodes, volume of drainage, hospitalization days and postoperative bladder function recovery time(P＞0.05)between the two groups. Conclusions Laparoscopic radical hysterectomy for cervical cancer is safe and reliable, which can reduce operative bleeding, increase the resection of parametrium and help with the intestinal function recovery quickly.     

Proximal gastric cancer: lymph node metastatic patterns according to different T stages dictate surgical approach

Background As a common form of gastric cancer migration,lymph node metastasis largely affects the surgical treatment and prognosis of gastric cancer.Surgery is the fundamental curative option for gastric cancer that varies depending on different stages.The study aimed to compare the clinicopathological characteristics and lymph node metastatic patterns in patients of proximal gastric cancer with different T stages and investigate a reasonable radical gastrectomy approach in terms of the range of lymphadenectomy for proximal gastric cancer.Methods In our retrospective study,the data of 328 patients of proximal gastric cancer with different T stages were analyzed.By comparing the differences of lymph node metastatic rate and ratio,we investigated the clinicopathological characteristics and metastatic patterns of lymph nodes.Also,we were especially interested in the differences in survival rates between patients with and without No.5 and 6 group metastasis with the same TNM stage.Results The overall lymph node metastatic rate and ratio of advanced proximal gastric cancer were 73.4％ and 23.3％,respectively.The tumors of different T stages were statistically significant in size and differentiation degree （P ＜0.05）,multivariate analysis showed that the depth of tumor invasion was an independent risk factor for lymph node metastasis in proximal gastric cancer （RR,12.025; 95％ CI,2.326 to 62.157; P=0.003）.The overall survival rate of patients with No.5,6 group lymph node metastasis and those without was significantly different,but the differences in survival rates between patients with and without No.5 and 6 group metastasis with the same TNM stage were not statistically significant.Conclusions Different T stages in proximal gastric cancer showed different patterns and characteristics of lymph node metastasis.D2 lymphadenectomy in patients with early gastric cancer had little survival benefit because metastasis to level 2 nodes was rare.Therefore the range of the lymph node dissection in radical gastrectomy     

Is surgical treatment of cancer of the gastric cardia or esophagus associated with a concurrent major pulmonary operation feasible? One center’s experience

Background  Pulmonary complications are a major cause of mortality after operation for cancer of the gastric cardia or esophagus. Although the risk involved in gastric cardiectomy or esophagectomy associated with a concurrent major pulmonary operation is expected to be much higher, it has seldom been evaluated on the basis of clinical experience. The aim of this study was to investigate the possibility and feasibility of the gastric cardiectomy or esophagectomy associated with a major pulmonary operation.

Methods  From August 2003 to January 2011, 14 patients underwent concurrent gastric cardiectomy or esophagectomy and a major pulmonary operation in our hospital. This included eight for pulmonary invasion of esophageal carcinoma, and six for synchronous lung tumor. All patients underwent systematic lymph node dissection for cardiac or esophageal cancer. To prevent postoperative complications, the operative approach and dissection procedures for cardiac or esophageal carcinoma were modified according to the associated pulmonary operation and the extent of cancer invasion. All thoracotomies for cardiectomy or esophagectomy were performed on the same side as the major pulmonary operation.

Results  All patients underwent a curative operation. There were no deaths or postoperative complications in the six synchronous lung tumor patients. In the eight pulmonary invasion patients, one patient died of respiratory failure 11 days after operation, and postoperative complications developed in four of them, but none was fatal. Six patients were still alive.

Conclusions  Curative gastric cardiectomy or esophagectomy associated with concurrent major pulmonary operation is not contraindicated in patients in good condition. In selected patients, when the operative procedures for cardiectomy or esophagectomy are appropriately modified to minimize the effect of the associated pulmonary operation, the treatment is associated with a low operative morbidity and mortality with an acceptable long-term survival.

     

腹腔镜辅助与开腹手术治疗进展期胃癌的对比研究

目的 探讨腹腔镜辅助与开腹手术治疗进展期胃癌临床效果的差异。方法 回顾性分析2017年1月至2019年6月延安大学附属医院普外科手术治疗的进展期胃癌患者的临床资料,共纳入265例,其中行腹腔镜辅助胃癌根治术患者138例,行开腹手术胃癌根治术患者127例。按照不同切除范围将所有病例资料分为远端胃癌根治术和全胃根治性切除术两个亚组,在全胃根治性切除术组及远端胃癌根治术两个亚组内分别比较腹腔镜辅助与开腹手术组患者的一般情况、病理学检查结果及并发症之间的差异。结果 ①两组一般资料与临床病理学特征差异均无统计学意义,腹腔镜辅助远端胃癌根治术(Laparoscopically assisted distal gastrectomy,LADG)亚组术后8例(9.5%)发生并发症,传统开腹远端胃癌根治术(Open distal gastrectomy,ODG)亚组术后8例(11.1%)发生并发症,腹腔镜辅助组与开腹手术组术后并发症构成差异无统计学意义(P＞0.05)。将并发症按照Clavien-Dindo系统划分后再比较,差异仍无统计学意义。②腹腔镜辅助全胃根治性切除术(Laparoscopically assisted total gastrectomy,LATG)亚组术后共有6例(11.1%)发生并发症,传统开腹全胃根治性切除术(Open total gastrectomy,OTG)亚组共有6例(10.9%)发生术后并发症,腹腔镜辅助组与开腹手术组术后并发症构成差异无统计学意义(P＞0.05)。将并发症按照Clavien-Dindo系统划分后再比较,差异仍无统计学意义。结论 腹腔镜辅助胃癌根治术与开腹胃癌根治术在治疗进展期胃癌时,具有相同的安全性。     

腹腔镜辅助下远端胃癌D2根治术治疗进展期胃癌的疗效分析

目的 探讨腹腔镜辅助下远端胃癌D2根治术临床治疗进展期胃癌患者的效果。 方法 将2014年1月—2015年12月间在蚌埠市第三人民医院进行治疗的92例进展期胃癌患者,分为2组。对照组患者46例,临床给予开腹远端胃癌D2根治术治疗,观察组46例,临床给予腹腔镜辅助下远端胃癌D2根治术治疗。术后对2组患者围术期情况(手术时间、术中出血量、切口长度、术后下床活动时间、住院时间)、清除淋巴结数量、术后并发症情况进行统计,采用SPSS 18.0统计学软件对2组数据进行统计处理并对结果进行分析。 结果 2组患者均顺利完成手术。观察组手术时间、术中出血量、切口长度、术后下床活动时间、住院时间均明显小于对照组,差异有统计学意义(P＜0.05)。观察组术后并发症发生率为2.1%,明显小于对照组的13.0%,差异有统计学意义(P＜0.05)。观察组和对照组清除淋巴结数量分别为(25.4±3.1)枚和(23.1±4.3)枚,2组比较差异无统计学意义(P＞0.05)。 结论 腹腔镜辅助远端胃癌D2根治术治疗进展期胃癌相比于开腹远端胃癌D2根治术效果要好,且有创伤小、出血少、术后下床时间快、并发症小等优点。患者临床治疗时应依据个体情况,选择合适的治疗方法。      

快速康复外科与腹腔镜技术对围手术期胃癌患者的影响

目的通过对比研究,分析快速康复外科（fast track surgery,FTS）与腹腔镜技术（laparoscopy,LAP）对胃癌手术患者围术期的影响。方法 60例拟施行远端胃癌患者随机分为两组：腹腔镜手术组（LAP组;n=30）行腹腔镜辅助远端胃癌根治术;快速康复外科组（n=30）应用FTS方案进行围手术期处理并开腹远端胃癌根治术（open distal gas-trectomy,ODG）。比较两组患者围手术期术后血清白蛋白、血尿素氮、C反应蛋白、肠蠕动恢复时间、手术时间、术中出血量、术后住院时间、住院费用、并发症发生等情况。结果 LAP组与FTS组各项指标水平在术前及术后各时相差异均无统计学意义（P〉0.05）,但术后FTS组ALB水平变化较LAP组更为缓和（P〈0.05）;LAP组较FTS组手术时间明显延长（P〈0.01）,术后肠蠕动恢复时间、术后住院时间无统计学差异,LAP组住院费用明显高于FTS组（P〈0.001）;两组术后并发症无统计学差别（P〉0.05）。结论 FTS＋ODG具有与LAP相近的促进胃癌病人术后恢复的近期效果,但更为经济、有效、安全、可行。     

腹腔镜辅助与开腹近端胃癌根治术的比较

目的：探讨腹腔镜辅助近端胃癌根治术的可行性及临床效果。方法：对2010年1月至2012年12月38例行腹腔镜辅助近端胃癌根治术患者（腹腔镜组）临床资料和同期我院行传统开腹近端胃癌根治术患者（开腹组）40例进行回顾性分析,比较两组手术安全性、术后并发症和手术病理情况。结果：腹腔镜组术中出血量、切口长度显著低于开腹组。腹腔镜组手术平均用时与开腹组相比差异无统计学意义（[336±26）min vs（322±41）min,P〉0.05]。腹腔镜组与开腹组肿瘤近切缘长度相比差异有统计学意义（[3.6±0.7）cm vs（5.3±1.1）cm,P〈0.05],远切缘相比差异无统计学意义（[6.7±1.1）cm vs（6.6±0.6）cm,P〉0.05]。腹腔镜组淋巴结清扫数量为（25±7）枚,开腹组为（23±5）枚,两组相比差异无统计学意义。腹腔镜组术后并发症的发生率与开腹组相比差异无统计学意义。结论：腹腔镜辅助近端胃癌根治手术能够达到与开腹手术相当的淋巴结清扫效果,并且手术创伤较小;辅助小切口下,处理近端切缘手术操作较为困难,可能存在切缘相对不足的情况,近端胃癌腹腔镜手术应特别关注近端切缘手术处理。     

腹腔镜辅助下胃癌根治术22例报告

目的探讨腹腔镜辅助下胃癌根治术的手术方法及效果。方法回顾分析22例腹腔镜胃癌根治术的临床资料,近端胃大部切除术3例,远端胃大部切除术19例。结果22例病人均顺利完成腹腔镜手术,无中转开腹。平均手术时间195 min（180～250 min）,平均出血量130 ml（85～170 ml）,平均下床活动时间52 h（41～61 h）,平均排气时间75 h（58～92 h）,平均住院时间9天（7～17天）。术后并发症3例,均经保守治疗治愈。结论腹腔镜辅助下胃癌根治术,在保留腹腔镜手术微创优点的同时减少了腔镜下的操作步骤,降低了腹腔镜胃癌根治术的手术难度,具有较好的临床应用价值。     

完全腹腔镜与腹腔镜辅助远端胃癌根治术疗效比较的Meta分析

目的:探讨完全腹腔镜远端胃癌根治术(TLDG)与腹腔镜辅助远端胃癌根治术(LADG)的安全性和有效性。 方法:计算机检索PubMed、Cochrane Library、中国期刊全文数据库(CNKI)和数字化期刊全文数据库(万方数据库),收集2004-2014年间发表的TLDG与LADG对比的文献,利用RevMan 5.3软件进行Meta分析。结果:共10篇文献被纳入本次Meta分析,共计2 212例胃癌患者,其中TLDG组930例,LADG组1282例。本次Meta分析结果显示,与LADG组比较,TLDG组术中出血少[均数差(WMD)=-20.70,95%CI:-30.81~-10.59,P<0.01]、术后止痛剂使用次数少(WMD=-0.38,95%CI:-0.74~-0.02,P=0.04)和淋巴结清扫数目多(WMD=2.98,95%CI:0.71~5.26,P=0.01),而手术时间、术后首次排气时间、首次进流食时间、术后住院时间、近端切缘距离、术后第1天C反应蛋白水平、术后总体并发症及吻合口并发症发生率比较差异均无统计学意义(均P>0.05)。结论:TLDG治疗远端胃癌安全可行,可取得与传统LADG相当的手术疗效,不增加术后并发症,且具有术中出血少和术后疼痛轻等优点。     

完全腹腔镜与腹腔镜辅助进展期远端胃癌根治术的近期疗效比较

将腹腔镜下远端胃癌 D2根治术的61例患者随机分为 TLDG 组与 LADG 组,对比分析两组患者的临床资料。TLDG 组32例中行 BⅠ式吻合（残胃十二指肠三角吻合）21例,残胃空肠 Roux-en-Y 吻合11例;LADG 组胃癌根治29例中行 BⅠ式吻合20例,残胃空肠 Roux-en-Y 吻合9例。两组在平均手术时间、术中出血量、平均肿瘤下切缘、平均肿瘤上切缘、切除淋巴结枚数方面相比差异无统计学意义。TLDG组术后未使用镇痛药,LADG 组平均使用镇痛药（2.5±0.4） d（P <0.05）;TLDG 组在术后通气时间、术后第1次下床时间方面明显短于 LADG 组,差异有统计学意义（ P <0.05）;两组术后早期并发症相比差异无统计学意义。     

加速康复外科模式下腹腔镜与开腹胃癌根治术的临床效果:基于中国多中心数据分析

目的 比较加速康复外科（ERAS）模式下腹腔镜与开腹手术的治疗效果。 方法 对2015年1月~2017年12月国内12家医疗中心1569例接受胃癌根治术患者的临床病理资料进行回顾性研究分析,其中接受开腹手术患者共522例,腹腔镜手术患者共1004例,腹腔镜中转开腹患者共43例。比较腹腔镜组和开腹组患者术中相关指标及术后并发症等情况,主要研究终点是术后短期并发症发生率,次要研究终点是手术时间、术中出血量、淋巴结清扫数目、术后首次进食全流时间、首次排气时间、排便时间、下床活动时间、术后住院时间及出院后30 d内因并发症再入院情况等。 结果 1569例患者中,男性1037例（66.1%）,女性532例 （33.9%）,发病年龄58.4±11.3岁。近端胃切除术105例（6.7%）,远端胃切除术877例（55.9%）,全胃切除术587例（37.4%）。患者手术时间274.7±80.7 min,中位出血量为150（20~1300）mL,淋巴结清扫数目29.9±13.5枚。术后首次下床活动时间2.3±1.2 d,首次排气时间3.4±1.6 d,首次排便时间4.8±1.8 d,首次进食全流时间5.5±3.1 d,术后住院时间11.4±5.0 d。术后按Clavien-Dindo分 级≥Ⅱ级的并发症发生率为6.5%,术后30 d因并发症再入院率为1.1%。按手术方式分为腹腔镜组及开腹组（腹腔镜中转开腹病例归为开腹手术）。两组患者胃切除范围差异无统计学意义（P>0.05）;腹腔镜组淋巴结清扫数目多于开腹组,术中出血量、术后首次下床活动时间、进食全流时间、首次排气时间、排便时间和术后住院时间均少于开腹组（P<0.05）;腹腔镜组手术时间长于开腹组（P<0.05）;两组术后并发症差异无统计学意义（P>0.05）。 结论 腹腔镜手术应用于胃癌加速康复外科,相较于开腹手术能缩短术后首次下床活动、排气、排便、进食全流时间及术后住院时间,并可获得同样的肿瘤学根治效果,且不增加术后并发症的发生率。