手术时间对腹腔镜辅助远端胃癌D2根治术患者的影响

目的探讨手术时间的长短对腹腔镜辅助远端胃癌D：根治术患者的影响及影响手术时间的相关因素。方法回顾性分析2007年1月至2010年12月间在福建医科大学附属协和医院胃外科接受腹腔镜辅助远端胃癌D2根治术的322例患者的临床资料,按手术时间分为长时间组（大于或等于205min,119例）和短时间组（小于205min．213例）。结果与短时间组比较,长时间组患者术中出血量较多（81．0±65．7）ml比（65．8±55．0）ml],术后下床时间（3．1±1．7）d比（2．3±1．2）d]、排气时间（3．8±1．1）d比（3．2±1．3）d和住院时间（14．2±6．3）d比（12．5±7．0）d]较长,术后并发症发生率较高16．0％（19／119）比8．5％（18／213）],差异均有统计学意义（均P〈0．05）;但两组术中输血例数、进食流质时间及病死率的差异无统计学意义（均P〉0．05）。多因素回归分析显示,体质量指数（P〈0．01）、淋巴结转移（P〈0．05）和手术经验（P〈0．01）是影响腹腔镜辅助远端胃癌D：根治术手术时间长短的独立因素。结论初期开展腹腔镜辅助胃远端癌D：根治术者应选择BMI较小、淋巴结转移较少的病例,以缩短手术时间．减少术后并发症的发生。

Impact of operative time on patients undergoing laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for gastric cancer

Objective To investigate the effect of operative time on laparoscopy-assisted distal gastrectomy （LADG） with D2 lymph node dissection and the influencing factors of operative time. Methods Clinical data of 332 patients with gastric cancer undergoing LADG with D2 lymph node dissection from January 2007 to December 2010 were analyzed retrospectively. The average operative time was （205±56） minutes. Operative indices and postoperative recovery were compared between patients with operative time I〉205 min （long-time group） and operative time 〈205 min （short-time group）. Results The mean blood loss （81.0±65.7） ml vs. （65.8±55.0） ml], time to ambulation （3.1±1.7） d vs. （2.3±1.2） d], time to first flatus （3.8±1.1） d vs. （3.2±1.3） d], postoperative hospital stay （14.2±6.3） d vs. （12.5±7.0） d], and postoperative complication 16.0%（19/119） vs. 8.5%（18/213） ] between long-time group and short-time group were significantly different（all P〈0.05）, while there were no significant differences in transfused patients, time to resume soft diet, and mortality （all P〉0.05）. Multivariate logistic regression analysis revealed that BMI（P〈0.01 ）, lymph node metastasis （P〈0.05）, and surgeon experience（P〈0.01） were independent risk factors for operation time. Conclusion Surgeons who have limited experience in LADG with D2 lymph node dissection should operate on patients with low BMI and less lymph node metastasis in order to reduce postoperative complications.