3D腹腔镜平行重叠吻合联合经自然腔道取标本在近端胃癌根治术中的应用价值

目的 观察女性近端胃癌患者3D腹腔镜根治术中行平行重叠吻合法消化道重建,并经自然腔道取标本在淋巴结清扫、术后胃肠功能恢复中的作用,探讨其治疗效果及安全性.方法 女性近端胃癌患者36例,其中16例行3D腹腔镜近端胃癌根治术,术中行平行重叠吻合法消化道重建,并经自然腔道取标本者为观察组;20例行2D腹腔镜近端胃癌根治术,术...

Application of natural orifice specimen extraction surgery combined with three-dimensional laparoscopical parallel and cross-to-overlap anastomosis in proximal radical gastrectomy

Objective To observe the clinical role of three-dimensional laparoscopic parallel and cross-to-overlap anastomosis(PCOA)combined with natural orifice specimen extraction surgery(NOSES)in proximal radical gastrectomy in lymph node dissection and postoperative gastrointestinal function recovery,and to investigate the operation outcome and safety in female patients with proximal gastric cancer.Methods In 36 female patients with proximal gastric cancer,16 patients underwent three-dimensional laparoscopic proximal radical gastrectomy with PCOA+NOSES(observation group)and the other 20 patients underwent two-dimensional laparoscopic proximal radical gastrectomy with transabdominal specimen extraction(control group).The operation time,intraoperative anastomosis time,intraoperative blood loss,and the number of lymph node dissection were compared between two groups.The exhaust time after operation,postoperative off-bed activity time,length of hospital stay,liquid diet time,and complications were observed.The follow-up lasted from 2 to 20 months,and the recurrence and metastasis of cancer as well as death of the patients were observed.Results The intraoperative anastomosis time,exhaust time after operation,postoperative off-bed activity time and length of hospital stay were shorter in observation group((32.5±5.5)min,(2.1±0.9)d,(1.2±0.7)d,(7.3±1.5)d)than those in control group((36.4±3.6)min,(2.9±1.1)d,(2.1±1.3)d,(8.5±1.3)d)(P<0.05),the intraoperative blood loss was less and the number of lymph node dissection was more in observation group((120.6±70.1)mL,28.4±4.2)than that in control group((165.2±53.6)mL,25.1±3.2)(P<0.05),and the operation time and liquid diet time showed no significant differences between two groups(P>0.05).No postoperative complications occurred in observation group.In control group,anastomotic stenosis occurred in one patient,and fat liquefaction occurred in one patient.During follow-up,no relapse,metastasis or death was found in two groups.Conclusion Three-dimensional laparoscopic proximal radical gastrectomy with PCOA+NOSES can increase the number of lymph node dissections,improve gastrointestinal function recovery,and shorten the length of hospital stay in female patients with proximal gastric cancer.