经脐单孔腹腔镜与传统五孔腹腔镜远端胃切除术近期疗效及生活质量的前瞻性对照研究

目的:对比单孔腹腔镜远端胃切除术(SLDG)与传统五孔法腹腔镜远端胃切除术(MLDG)对胃癌患者近期疗效及术后生活质量的影响。方法:将2018年8月至2019年6月收治的86例胃癌患者按计算机产生随机数字的方法随机分为SLDG组(n=42)与MLDG组(n=44),对比分析两组术中、术后相关指标,同时采用欧洲癌症研究与治疗组织制定的生活质量问卷(QLQ-C30)、胃癌模块生活质量问卷(QLQ-ST022)评估患者术后1周、1个月的生活质量。结果:两组患者年龄、BMI、ECOG评分、重建方式、淋巴结清扫数量、术后病理、文化背景等差异无统计学意义。SLDG组手术时间(207.14±31.68)min vs.(172.26±28.95)min,P<0.05]长于MLDG组,术中出血量、术后首次排气时间、引流管留置时间、术后住院时间优于MLDG组(P<0.05)。MLDG组3例(6.8%)发生并发症,SLDG组发生2例(4.8%)。住院期间两组均未出现死亡病例,无出院后30 d内再入院病例。SLDG组患者术后1周QLQ-C30量表中总体健康状况、躯体功能、角色功能、社会功能评分均高于MLDG组(P<0.05),术后疼痛、疲倦、恶心呕吐症状较MLDG组更轻(P<0.05);术后1个月时,两组患者QLQ-C30评分差异较前缩小,总体生活质量较术后1周明显好转。但在身体外观、焦虑方面差异仍有统计学意义(P<0.05)。结论:SLDG与MLDG治疗进展期胃癌具有相同的手术效果,安全、可行,SLDG术后患者总体生活质量更高,在腹腔镜胃癌手术中具有良好的应用前景。

A prospective controlled study of short-term efficacy and quality of life of transumbilical single-port laparoscopy and conventional five-port laparoscopic distal gastrectomy

Objective:To compare the short-term effects of single-incision laparoscopic distal gastrectomy(SLDG)and conventional multi-port laparoscopic distal gastrectomy(MLDG)for gastric cancer patients and its impact on postoperative quality of life.Methods:Eighty-six patients with gastric cancer who underwent surgery at the First Affiliated Hospital of Nanchang University from Aug.2018 to Jun.2019 were randomly divided into SLDG group(n=42)and MLDG group(n=44),the intraoperative and postoperative outcomes of the two groups were compared,and the quality of life questionnaire(QLQ-C30)developed by the European Organization for Research and Treatment of Cancer and the gastric cancer module quality of life questionnaire(QLQ-ST022)were used to assess the quality of life 1 week and 1 month after surgery.Results:There were no significant differences in age,BMI,ECOG score,reconstruction pattern,number of lymph nodes dissection,postoperative pathology,and cultural background between the two groups.The operation time of the SLDG group was longer than that of the MLDG group(207.14±31.68)min vs.(172.26±28.95)min,P<0.05].However,the intraoperative blood loss,the first anal exhaust after the operation,time of the drainage tube indwelled,postoperative hospital stay were better in the SLDG group than those in the MLDG group(P<0.05).There were 3(6.8%)complications in the MLDG group and 2(4.8%)complications in the SLDG group.There were no deaths during hospitalization and no readmitted cases within 30 days after discharge in the two groups.In the SLDG group,the overall health status,physical function,role function,and social function scores of the QLQ-C30 scale after 1 week were significantly higher than those of the MLDG group(P<0.05).Postoperative pain,fatigue,nausea and vomiting were less than MLDG group(P<0.05).At 1 month after operation,the differences in QLQ-C30 scores between the two groups were smaller than before,and the overall quality of life improved significantly compared with that 1 week after surgery.However,there were still statistical differences in body appearance and anxiety(P<0.05).Conclusions:SLDG and MLDG have the same surgical results in the treatment of advanced gastric cancer,is safe and feasible.The overall quality of life of SLDG is higher,it has good application prospect in laparoscopic gastric cancer surgery.