加速康复外科理论指导的腹腔镜辅助远端胃癌根治术对胃癌患者体液免疫功能的影响

目的 观察加速康复外科(fast track surgery,FTS)概念指导下腹腔镜辅助远端胃癌根治术(laparoscopy assisted distal gastrectomy,LADG)对胃癌患者炎症应激反应和体液免疫功能的影响.方法 选择烟台毓璜顶医院2009年1月至2010年11月期间入院接受手术治疗的82例远端胃癌患者,随机分为4组:FTS+ LADG组(19例)、LADG组(22例)、FTS+开腹远端胃癌根治术(open distalgastrectomy,ODG)组(21例)和ODG组(20例),检测4组患者的血清CRP、C3、CA、IgG、IgA、IgM并进行对比分析.结果 ODG组血清CRP术后水平和变化幅度明显高于其他3组(均P＜0.01、均P＜0.05),其中FTS+ LADG组在术后变化幅度低于FTS+ ODG组(均P＜0.05).FTS+ LADG组血清C3、CA水平高于ODG组(P ＜0.05、P＜0.05).血清C3水平变化幅度在其他3组明显低于ODG组(均P ＜0.05).血清C4水平变化幅度以FTS+ LADG组最低(P＜0.05),其次为LADG组(P＜0.01),ODG组最高(P＜0.05).术后其他3组血清IgG、IgA水平均高于ODG组(均P＜0.01).FTS+ LADG组的血清IgM水平变化幅度在第1～4天低于ODG组(P＜0.01).结论 FTS的围手术期处理和腹腔镜技术均可以减轻围手术期炎症应激反应,二者联合应用有一定的优势.     

腹腔镜手术对早期远端胃癌短期疗效的meta分析

目的:通过meta分析评估早期远端胃癌根治术中腹腔镜手术的短期临床疗效与安全性。方法:从Pub Med、Cochrane library等数据库中搜索2014年4月以前发表的研究对象为腹腔镜辅助远端胃大部切除术(laparoscopy-assisted distal gastrectomy,LADG)、开腹远端胃癌根治术(open distal gastrectomy,ODG)治疗早期远端胃癌患者近期疗效的随机对照试验(randomized controlled trials,RCT)文献,采用Rev Man 5.2软件对纳入的数据进行meta分析。结果:共7篇RCT纳入本研究。纳入病例数为692例,其中LADG组354例,ODG组338例,meta分析结果提示:两组患者进食时间[加权均数差(WMD)=-0.49,95%CI(-1.45,0.47)]与术后住院时间[WMD=-1.44,95%CI(-3.17,0.29)]差异无统计学意义,LADG组手术时间较长[WMD=82.91,95%CI(58.59,107.24)],淋巴结清扫数量略少[WMD=-4.62,95%CI(-6.58,-2.66)];但术中出血量[WMD=-103.58,95%CI(-140.75,-66.42)]更少,术后排气时间[WMD=-0.55,95%CI(-1.02,-0.08)]更短,术后早期并发症发生率[比值比(OR)=0.44,95%CI(0.27,0.70)]更低。结论:腹腔镜早期远端胃癌根治术后患者肠道功能恢复较快,并发症较少,短期效果优于开腹手术。     

胃十二指肠三角吻合术应用于胃癌全腹腔镜远端胃切除术的可行性分析

目的:探讨胃十二指肠三角吻合术应用于胃癌全腹腔镜远端胃切除术的可行性分析。方法:选择2014年1月至2014年12月收治的30例接受全腹腔镜远端胃切除术(totally laparoscopic distal gastrectomy,TLDG)并D2淋巴结清除术的胃癌患者作为全腹镜组(TLDG组),34例行腹腔镜辅助胃切除术(laparoscopic assisted distal gastrectomy,LADG)并D2淋巴结清除术的患者作为腹腔镜辅助组(LADG组),观察两组患者手术时间、消化道重建时间、术中出血量、肿瘤大小、淋巴结清扫数量、边缘距离、术后首次肛门排气时间、术后恢复饮水时间、进食半流质时间、住院时间及随访6个月并发症情况。结果:TLDG组患者手术时间、消化道重建时间长于LADG组,术中出血量少于LADG组,远端切缘距离长于LADG组,差异均有统计学意义(P<0.05),两组肿瘤大小、近端切缘距离、淋巴结清扫数量、术后首次肛门排气时间、恢复饮水时间、进食半流质时间、术后住院时间差异无统计学意义(P>0.05)。TLDG组术后并发症发生率为13.3%,LADG组为8.8%,两组差异无统计学意义(P>0.05)。结论:完全腹腔镜胃十二指肠三角吻合术安全、可行,是胃癌患者较理想的消化道重建手术方法。     

腹腔镜与开腹胃癌根治术的临床效果对比

目的:对比腹腔镜辅助胃癌根治术与开腹胃癌根治术的临床疗效,探讨腹腔镜辅助胃癌根治术的可行性、安全性及有效性。方法:回顾分析2014年7月至2015年2月手术治疗的胃癌患者的临床资料,其中21例行开腹远端胃癌根治术;27例行腹腔镜辅助远端胃癌根治术(laparoscopically assisted distal gastrectomy,LADG);20例行开腹根治性全胃切除术;24例行腹腔镜辅助根治性全胃切除术(laparoscopically assisted total gastrectomy,LATG)。对比分析四组患者手术时间、术中出血量、术后住院时间、术后相关并发症等情况。结果:与开腹手术相比,LADG组、LATG组手术时间显著延长,但在术中出血量、胃肠功能恢复时间、术后引流管拔除时间、术后住院时间等方面具有优势。结论:腹腔镜辅助胃癌根治术安全、可靠,近期疗效肯定,具有切口小、出血少、康复快等优势,值得临床推广。     

单孔加一孔腹腔镜远端胃癌根治术的近期疗效分析

目的 探讨单孔加一孔腹腔镜技术在根治性远端胃癌手术中的可行性及优势。方法 回顾性收集2019年9月至2021年9月期间于潍坊市人民医院胃肠外科行单孔加一孔腹腔镜远端胃癌根治术(single incision plus one port laparoscopic distal gastrectomy, SILDG+1)的44例病人的临床资料(SILDG+1组);收集同期由同一手术团队行传统五孔腹腔镜远端胃癌根治术(multi-port laparoscopy distal gastrectomy, MLDG)的48例病人作为对照(MLDG组),比较两组术后胃肠道功能、机体应激及炎性反应状态、美学效果。结果 围手术期指标结果显示：SILDG+1组与MLDG组比较，手术时间长[(219.1±15.1) min比(196.3±23.0) min,P<0.001],出血量少[(96.7±14.8) mL比(105.3±18.1) mL,P=0.015],术后首次下床时间短[(31.14±5.84) h比(39.21±5.26) h,P<0.001],术后首次肛门排气时间短[(1.98...     

胃十二指肠三角吻合在全腹腔镜胃癌切除术中的应用初探

目的探讨胃十二指肠三角吻合在全腹腔镜远端胃癌切除术(totally laparoscopic distal gastrectomy,TLDG)中应用的可行性。方法回顾性收集2013年12月至2015年12月期间于孝感市第一人民医院行TLDG或腹腔镜辅助远端胃癌切除术(laparoscopic assisted distal gastrectomy,LADG)的90例胃癌患者的临床资料。其中行TLDG 45例(TLDG组),行LADG 45例(LADG组)。比较2组患者的手术时间、术中出血量、消化道重建时间、近远端切缘距离、清扫淋巴结数量、术后肛门首次排气时间、术后开始饮水时间、术后开始进食半流质饮食时间、住院时间及并发症发生情况,评价胃十二指肠三角吻合应用于TLDG的可行性。结果 1术中情况。TLDG组患者的手术时间、消化道重建时间及远端切缘距离均长于(大于)LADG组(P0.050),术中出血量少于LADG组,但2组患者的清扫淋巴结数量及近端切缘距离比较差异均无统计学意义(P0.050)。2术后情况。2组患者的术后肛门首次排气时间、术后开始饮水时间、术后开始进食流质饮食时间、住院时间及并发症发生率比较差异均无统计学意义(P0.050)。术后所有患者均获得6个月及以上的随访,随访时间为6~16个月,中位数为10个月。随访期间,2组均未见肿瘤复发患者,也未见明显的吻合口狭窄或吻合口梗阻患者。结论 TLDG中应用胃十二指肠三角吻合重建消化道具有良好的可行性及安全性,是胃癌患者消化道重建的可靠方法,值得在临床上推广应用。     

腹腔镜D2根治术治疗无浆膜层侵犯的进展期胃癌129例

目的：评价腹腔镜胃癌D2根治术治疗无浆膜层侵犯的进展期胃癌的可行性、安全性及疗效。方法：129例无浆膜层侵犯的进展期胃癌患者中,32例（24.8%）行完全腹腔镜远端胃切除术（total laparoscopic distal gastretomy,TLDG）,43例（33.3%）行腹腔镜辅助全胃切除术(laparoscopic-assisted total gastrectomy,LATG),54例（41.9%）行腹腔镜辅助远端胃切除术(laparoscopic-assisted distal gastrectomy,LADG)。结果：本组129例手术均获成功,手术时间为(196±35.5) mins,术中出血量(150±40) mL,术后肠功能恢复时间为(2.7±0.7) d,淋巴结清扫数平均(26±4)枚;术后随访13~70个月,15例有局部复发或远处转移,死亡4例。结论：腹腔镜胃癌D2根治术治疗无浆膜层侵犯的进展期胃癌安全、可行,具有创伤轻、恢复快等优点,有着较好的近远期疗效。     

快速康复外科在胃癌根治术围手术期护理中的应用

目的探讨快速康复外科(FTS)在胃癌根治术围手术期护理中的应用效果。方法将64例接受胃癌根治术的胃癌患者按入院时间分为2组,对照组实施常规护理,观察组在常规护理的基础上给予FTS护理措施。比较2组患者术后肛门恢复排气时间、首次进食时间和并发症发生率、住院时间及术前和术后3 d血清Ig A指标变化。结果观察组术后肛门恢复排气时间、首次进食时间和住院时间均短于对照组,术后并发症发生率低于对照组,差异有统计学意义(P0.05);2组术前血清Ig A指标比较,差异无统计学意义(P0.05)。术后2组血清Ig A指标较术前均有升高,其中观察组升高幅度明显高于对照组,差异有统计学意义(P0.05)。结论在胃癌根治术围手术期应用FTS护理,可促进术后胃肠功能恢复,提高机体免疫力,减少术后并发症,提高治疗效果。     

Feasibility of fast-track surgery perioperative radical gastrectomy for gastric cancer

目的 探讨快速康复外科理念在胃癌病人围手术期应用的可行性及价值.方法 将能行一期根治性切除胃癌病人337例,随机分为快速康复外科(FTS)治疗组(n=166)及传统方法治疗(TM)组(n=171).观察术前一般情况、手术情况、术后恢复情况、术后营养状况及并发症发生率.结果 FTS组因不能全程遵守FTS要求而剔除23例.两组病人术前一般情况、手术方式、手术时间、术中出血量、术中尿量差异无统计学意义(P＞0.05),但术中补液量FTS组小于TM组,差异有统计学意义(P＜0.05).两组均未出现麻醉误吸及围手术期死亡.首次排气时间[(67±31)h与(114±35)h]、首次排便时间[(112±42)h与(138±46)h]、术后住院时间[(10±2)d与(12±3)d],FTS组均短于TM组,差异均有统计学意义(P＜0.05);术后营养状况FTS组优于TM组,相关营养指标差异有统计学意义(P＜0.05).两组间术后相关并发症发生率差异无统计学意义(P＞0.05).结论 胃癌根治术围手术期行快速康复外科处理是安全、可行、有效的,能加速病人术后的恢复,并减轻病人痛苦,降低护士工作量.     

完全腹腔镜下远端胃癌根治术临床分析

目的比较全腹腔镜下(total laparoscopic distal gastrectomy,TLDG)与腹腔镜辅助远端胃切除术(laparoscopy-assisted distal gastrectomy,LADG)的疗效,探讨TLDG的安全性及可行性。方法系统性回顾2012年1月～2014年12月于我院微创外科中心行手术治疗并病理确诊的胃癌患者的临床资料及随访资料,其中行LADG患者138例,TLDG患者187例。结果两组患者年龄、性别、ASA评分、CEA水平、手术方式比较差异无统计学意义(P0. 05)。TLDG组患者在切口长度、术后住院时间、术后第1 d、第3 d疼痛评分及术后伤口感染方面均明显优于LADG组,差异均有统计学意义(P 0. 05),而两组手术时间、失血量、中转开腹例数、首次排气时间、首次进食时间、术后吻合口瘘、乳糜漏、出血及胃肠功能障碍、再手术等比较均无统计学差异(P0. 05)。术后病理显示TLDG组患者肿瘤明显小于LADG组(P 0. 05),但两组近、远端切缘距离、淋巴结清扫数目以及pTNM分期比较,差异均无统计学意义(P 0. 05)。LADG组中位随访时间为55(6～82)个月,TLDG组为60(10～81)个月。随访期内LADG组与TLDG组分别有15例和13例患者发生复发和(/或)远处转移,组间比较无统计学差异(P 0. 05)。两组患者总生存期(overall survival,OS)比较亦无统计学差异(P 0. 05)。结论在遵循恶性肿瘤手术原则的基础上,对于合适的(肿瘤较小)病例,TLDG可取得与LADG一样的治疗效果。     

Preliminary Experience of Fast-Track Surgery Combined with Laparoscopy-Assisted Radical Distal Gastrectomy for Gastric Cancer

Objective

The aim of this study was to evaluate the safety and effectiveness of fast-track surgery combined with laparoscopy-assisted radical distal gastrectomy for gastric cancer.

Methods

Eighty-eight eligible patients were randomly assigned into four groups: (1) fast-track surgery (FTS) + laparoscopy-assisted radical distal gastrectomy (LADG), treated with LADG and FTS treatment; (2) LADG, treated with LADG and traditional treatment; (3) FTS + open distal grastectomy (ODG), treated with ODG and FTS treatment; and (4) ODG, treated with ODG and traditional treatment. The clinical parameters and serum indicators were compared.

Results

Compared with the ODG group, the other three groups had earlier first flatus and shorter postoperative hospital stay (all P?<0.01; all P?<0.05), especially in the FTS + LADG group. The level of ALB was higher in the FTS + LADG group than in the LADG group at 4 and 7 days after surgery (P?<0.05, P?<0.01). The level of CRP in the FTS + LADG group was lower than in the FTS+ODG group at 4 and 7 days after surgery (P?<0.05, P?<0.05). The FTS + ODG group had lowest medical costs.

Conclusion

Combination of FTS and LADG in gastric cancer is safe, feasible, and efficient and can improve nutritional status, lessen postoperative stress, and accelerate postoperative rehabilitation. Compared with FTS + ODG and LADG, its advantages were limited in short-term follow-up.     

远端进展期胃癌腹腔镜辅助与开腹根治术的远期疗效比较

目的 探讨进展期胃癌腹腔镜根治术的安全性和可行性,并评价其远期临床疗效。方法 对2004年1月至2009年6月远端进展期胃癌行腹腔镜辅助胃癌根治术346例患者的临床及随访资料和同期在我院行传统开腹胃癌手术的313例进行回顾性分析,比较两组的手术安全性、术后并发症、生存率以及癌症复发转移情况。结果 腹腔镜组手术平均用时与开腹组相比差异无统计学意义[(211±56) min比（204±41）min,P＞0.05]。腹腔镜组术中出血量、切口长度显著低于开腹手术组。腹腔镜组肿瘤近、远端切缘长度分别为(6.3±2.0) cm、(5.7±1.7)cm,开腹组分别为(6.3±2.1) cm、(5.6±1.6) cm,两组相比差异均无统计学意义。腹腔镜组淋巴结清扫数量为(33±13)枚,开腹组为(33±16)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显著低于开腹组（6.7％比13.1％,P＜0.01）。随访时间6～72个月,平均37个月,腹腔镜组1、3、5年生存率分别为87.2％、57.2％和50.3％,开腹组分别为87.1％、54.1％和49.2％,两组相比差异均无统计学意义。两组癌症复发转移率相比差异无统计学意义。结论 腹腔镜辅助的进展期胃癌根治术与开腹组在生存率及术后复发方面无显著差异,且具有创伤小、术后恢复快、并发症少等优点。     

Transient Liver Dysfunction after Laparoscopic Gastrectomy for Gastric Cancer Patients

Introduction The effect of laparoscopic surgery under CO₂ pneumoperitoneum on liver function is not clear. The aim of this study was to clarify whether laparoscopy-assisted distal gastrectomy (LADG) is associated with changes in liver function compared with open distal gastrectomy (ODG). Methods A total of 205 patients who underwent LADG (n = 147) or ODG (n = 58) between January 1994 and April 2004 were included in this study. Liver function tests—aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin, total bilirubin—were examined before surgery and at 1, 3, and 7 days after surgery. The postoperative clinical course was compared between the two groups. Results AST levels on day 1 and ALT levels on days 1 and 3 were significantly higher in the LADG group. Albumin levels showed a marked decrease after operation in both groups, but the level recovered more rapidly in the LADG group than in the ODG group, showing significant differences on days 3 and 7. The total bilirubin levels remained unchanged from baseline. The postoperative complication rate was similar in the two groups, although 3 LADG patients among the 27 patients with liver disease suffered severe enteritis. Conclusions Transient liver dysfunction was documented in patients after laparoscopic gastrectomy under CO₂ pneumoperitoneum.     

腹腔镜辅助胃远端癌淋巴结清扫术近期疗效

目的探讨腹腔镜辅助胃远端癌D2淋巴结清扫术的可行性及近期疗效。方法2007年1月至2008年12月,对241例胃远端癌患者施行D2淋巴结清扫术。其中腹腔镜辅助远端胃大部切除术（LADG组）93例,常规开腹远端胃大部切除术（ODG组）148例。比较两组患者的淋巴结清扫数及术中、术后恢复情况、并发症发生率和住院死亡率。结果LADG组和ODG组患者淋巴结清扫数分别为（27．5±9．1）枚和（27．3±8．5）枚,两组差异无统计学意义（P〉0．05）。按肿瘤浸润深度进行分层分析,T1、T2、T3期患者两组平均清扫淋巴结数差异均无统计学意义（P〉0．05）。LADG组手术时间显著长于ODG组,但术中出血量、输血例数、术后首次下床时间、肛门排气时间、进流质时间、住院时间和手术并发症发生率均显著少于ODG组,两者差异有统计学意义（P〈0．05）。结论腹腔镜辅助胃远端癌D2淋巴结清扫术在淋巴结清扫方面能达到与开腹手术相同的效果,且具有安全、术后恢复快和并发症少等优点。     

Laparoscopy-assisted Gastrectomy for Early Gastric Cancer in Young and Elderly Patients

Open gastric surgery in elderly patients is associated with higher morbidity and mortality rates than those reported among younger individuals. Therefore, minimally invasive surgery may have a larger impact on the elderly compared to the younger age group. The objective of this study was to evaluate the experience of laparoscopy-assisted distal gastrectomy (LADG) in patients with early gastric cancer and compare the results in patients 70 years of age and older to those in patients younger than 70 years of age. From January 1998 to October 2004, a total of 103 patients underwent LADG. Of these patients, 30 who were older than 70 years were compared with 73 who were younger. Preoperative co-morbidity, operative results, postoperative outcomes, and survival were analyzed. Furthermore, as a standard control of this study, we reviewed 54 distal gastrectomy cases with open surgery (open distal gastrectomy; ODG) in the same term with the same background factors, categorized into elder (n = 16) and younger (n = 38). The mean age of the elderly patients was 75 years in the LADG group. A significantly higher proportion of elderly patients had concurrent diseases in both groups. Blood loss was significantly less in the elderly than in younger patients undergoing LADG, and it was less in the LADG group than in the ODG group. The overall 5-year survival rates in the LADG group were not significantly different between elderly and younger patients. Laparoscopy-assisted distal gastrectomy is a safe and effective treatment for early gastric cancer in the elderly. Therefore, chronological age alone should not be considered a contraindication in selecting patients for LADG.     

Comparative study of laparoscopy-assisted distal gastrectomy and open distal gastrectomy

BACKGROUND: Most studies comparing surgical results of laparoscopic procedures for gastric cancer with open gastrectomies have been conducted based on limited experience. We aimed to compare laparoscopy-assisted distal gastrectomy (LADG) and conventional open distal gastrectomy (ODG) after a protracted learning experience. STUDY DESIGN: We retrospectively reviewed medical records data. Two hundred fifty six patients underwent distal gastrectomies (136 LADG, 120 ODG). There were 150 early gastric cancer (EGC) patients (120 LADG, 30 ODG). RESULTS: Mean operation times for LADG and ODG were similar among EGC (156.5 versus 159.3 minutes, p = 0.666). Mean retrieved lymph node counts for LADG and ODG were different, but were > 30 (31.3 versus 40.4 for all and 30.4 versus 38.1 for EGC). For all subjects or EGC patients after LADG, C-reactive proteins on day 5 were substantially lower, first liquid diet was resumed substantially sooner, and postoperative hospital stays were substantially shorter than for ODG. CONCLUSIONS: LADG with lymph node dissection after a learning curve has several advantages compared with ODG, namely, less inflammatory reaction, rapid return of gastrointestinal function, and shorter hospital stay without compromising operation time or operative curability.     

T lymphocyte subsets and Th1/Th2 balance after laparoscopy-assisted distal gastrectomy

Background: Laparoscopic surgery provides for a less invasive procedure than open surgery in patients with gastric cancer, but the immune responses after laparoscopic surgery for early gastric cancer remain unknown. Methods: Peripheral blood mononuclear cells from 20 patients with early gastric cancer who underwent laparoscopy-assisted distal gastrectomy (LADG) or open distal gastrectomy (ODG) were obtained; the cell surface molecules and intracellular cytokines (IFN-gamma and IL-4) were measured by flow cytometry. Results: The populations of T lymphocytes after LADG, including CD3-, 4-, 8-, 57-, and HLA-DR-positive lymphocytes, showed patterns similar to those after ODG. The production of IFN-gamma as Th1 cell function decreased significantly on the third postoperative day after ODG but increased after LADG. The production of IL-4, representing Th2 cell function, increased postoperatively after ODG but not after LADG. Conclusions: When compared with ODG, LADG contributes to the preservation of postsurgical Th1 cell-mediated immune function.     

Laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for gastric cancer: technical and oncologic aspects

Background Laparoscopy-assisted distal gastrectomy (LADG) with lymph node dissection for advanced gastric cancer is still controversial. To evaluate the technical and oncologic feasibility and advantage of LADG with D2 lymph node dissection, the authors compared the surgical outcomes of LADG with D2 dissection and those of conventional open distal gastrectomy (ODG) for patients with early gastric cancer (EGC). Methods Between September 2004 and August 2005, the study enrolled 75 patients with a preoperative diagnosis of EGC. Of these 75 patients, 44 underwent LADG, and remaining 31 underwent ODG. All the patients received D2 lymph node dissection. Their clinicopathologic characteristics, postoperative outcomes, and retrieved lymph nodes were compared at each station. Results Although the operative time was significantly longer for the LADG group than for the ODG group, the perioperative recovery was shorter and, consequently, the postoperative hospital stay was significantly shorter for the LADG group (7.7 vs 9.4 days, respectively; p = 0.003). No significant differences were found in the total number of retrieved lymph nodes (37.2 vs 42.4; p > 0.05) or node stations (p > 0.05) between the two groups. Conclusions LADG with D2 lymph node dissection is a safe and feasible procedure, and it is oncologically compatible with open gastrectomy. A large-scaled prospective randomized trial with advanced gastric cancer patients should be conducted to confirm the benefit of LADG. Part of this article was presented and awarded the Best Video Award at the 14th International Congress of EAES, Berlin, Germany, 13–16 September 2006     

腹腔镜与开腹胃癌根治术后早期并发症状性胸腔积液的回顾性研究

目的比较腹腔镜与开腹胃癌根治术后早期并发症状性胸腔积液的差异性。方法回顾性分析2014年1月至2016年10月在华中科技大学同济医学院附属协和医院胃肠外科实施胃癌根治术的678例病人的临床资料。结果 678例胃癌根治术中66例术后出现了症状性胸腔积液,发生率为9.7%。腹腔镜组327例,术后胸腔积液为11例,发生率为3.4%;开腹组351例,术后胸腔积液为55例,发生率为15.7%,差异有统计学意义(χ2=29.17,P0.05)。腹腔镜组中远端胃、近端胃、全胃、联合脏器切除分别为189例、38例、69例、31例,术后胸腔积液的例数分别为2例、3例、4例、2例,发生率分别为1.1%、7.9%、5.8%、6.5%。近端胃、全胃与联合脏器切除术后并发胸腔积液发生率之间比较,差异无统计学意义(P0.05)。但三者与远端胃术后并发胸腔积液发生率之间比较,差异有统计学意义(P0.05)。开腹组中远端胃、近端胃、全胃、联合脏器切除分别为122例、78例、114例、37例,术后胸腔积液的例数分别为8例、18例、19例、10例,发生率分别为6.6%、23.1%、16.7%、27.0%。近端胃、全胃与联合脏器切除术后并发胸腔积液发生率之间比较,差异无统计学意义(P0.05)。但三者与远端胃术后并发胸腔积液发生率之间比较,差异有统计学意义(P0.05)。分别对腹腔镜组与开腹组间远端胃、近端胃、全胃和联合脏器切除术后胸腔积液的发生率进行比较,差异均有统计学意义(P0.05)。结论腹腔镜手术可能会减少胃癌根治术后早期症状性胸腔积液的产生。     

Short-term outcomes of laparoscopic-assisted distal gastrectomy for gastric cancer during a surgeon’s learning curve period

Background

Laparoscopy-assisted distal gastrectomy (LADG) is gaining wider acceptance for treating early gastric cancer (EGC). However, many gastric surgeons are still reluctant to perform LADG, mainly because this procedure entails a considerable learning curve. We aimed to evaluate the technical feasibility and short-term outcomes of performing LADG by a single experienced gastric surgeon who initially had no experience with laparoscopic surgery as compared with open distal gastrectomy (ODG).

Methods

Between January 2006 and December 2007, 177 patients with preoperatively diagnosed EGC located at the middle or lower third of the stomach were enrolled; 102 patients underwent LADG, 4 patients had open conversion, and 71 patients underwent conventional ODG. The operative and early postoperative outcomes from a prospective database were compared between the two groups.

Results

The clinicopathological characteristics were similar between the two groups. No operation-related deaths occurred. Although operation time was significantly longer for LADG than for ODG, time to first flatus was shorter and, consequently, postoperative hospital stay was significantly shorter in the LADG group. There was no significant difference in the overall complication rates between the two groups. On comparing the early (n = 50) and late groups (n = 52) of LADG patients, operation time and postoperative hospital stay were shorter and number of retrieved lymph nodes was greater in the late group (p < 0.05). Major and minor complications were markedly reduced in the late group (p < 0.05).

Conclusions

Although LADG was more time consuming than ODG, it was a feasible, safe procedure that accomplished the oncological requirements. Postoperative morbidity of LADG was similar to that of ODG, and LADG led to faster postoperative recovery. However, LADG should be performed carefully to prevent unexpected complications, especially during the early learning period.