文章摘要

完全腹腔镜与开腹全胃切除的疗效及术后并发症分析

作者: 1柳国富, 1柯志刚, 1徐江浩, 1洪晓辉
1 浙江大学附属第一医院浦江分院 普外肝胆外科
通讯: 柳国富 Email: lllgggfff123@yeah.net
DOI: 10.3978/.10.3978/j.issn.1005-6947.2017.10.016

摘要

目的：探讨完全腹腔镜与开腹胃癌根治术术中、术后情况的差异，以及并发症发生的影响因素。方法：回顾性分析2014年1月—2017年1月330例行根治性全胃切除术患者资料，其中150例行完全腹腔镜手术（腔镜组），另外180例行开腹手术（开放组），比较两组患者相关临床指标以及并发症情况，并分析并发症发生的影响因素。结果：两组患者术前资料具有可比性。与开放组比较，腔镜组手术时间延长，术中出血量、术后肠道功能恢复时间及术后住院时间均明显减少（均P<0.05）；淋巴结清扫数目两组间无统计学差异（P>0.05）；腔镜组术后的总并发症发生率明显低于开放组（8.67% vs. 32.22%，P<0.05），其中主要是在术后肠梗阻、腹腔出血、切口感染等外科并发症发生率低于开放组（6.67% vs. 31.66%，P<0.05），而两组非外科并发症总发生率无统计学差异（13.32% vs. 8.34%，P>0.05）。单因素分析显示，年龄、BMI、手术时间、术前患者的血清蛋白及血红蛋白水平、肿瘤大小、淋巴结转移、术前合并症均并为发症发生的影响因素（均P<0.05）。结论：完全腹腔镜下胃癌根治术的创伤小，术后恢复快，总的并发症控制优于开放性手术，推荐临床应用。
关键词： 胃肿瘤 胃切除术 腹腔镜 手术后并发症 影响因素分析

Totally laparoscopic versus open radical gastrectomy: an analysis of efficacy and postoperative complications

Authors: 1LIU Guofu, 1KE Zhigang, 1XU Jianghao, 1HONG Xiaohui
1 Division of Hepatobiliary Surgery, Department of General Surgery, Pujiang Branch of the First Affiliated Hospital, Zhejiang University

CorrespondingAuthor:LIU Guofu Email: lllgggfff123@yeah.net

Abstract

Objective: To investigate the difference in intra- and postoperative situations between totally laparoscopic and open radical gastrectomy, and the influential factors for complications. Methods: The clinical data of 330 gastric cancer patients undergoing radical gastrectomy from January 2014 to January 2017 were retrospectively analyzed. Of the patients, 150 cases underwent totally laparoscopic surgery (laparoscopic surgery group), and the other 180 cases underwent open surgery (open surgery group). The main clinical variables and complications were compared between the two groups of patients, and the influential factors for complications were analyzed. Results: The preoperative data were comparable between the two groups of patients. In laparoscopic surgery group compared with open surgery group, the operative time was prolonged, but the intraoperative blood loss, time for bowel function recovery and length of hospital stay were all significantly reduced (all P<0.05); the number of lymph node resection showed no significant difference (P>0.05). The overall incidence of postoperative complications in laparoscopic surgery group was significantly lower than that in open surgery group (8.67% vs. 32.22%, P<0.05), which was mainly responsible for the significantly reduced incidence of surgical complications such as intestinal obstruction, intra-abdominal hemorrhage, and incision infection (6.67% vs. 31.66%, P<0.05), but not for the incidence of non-surgical complications that showed no significant difference between the two groups (13.32% vs. 8.34%, P>0.05). Univariate analysis showed that age, BMI, operative time, preoperative levels of serum protein and hemoglobin, tumor size, lymph node metastasis and preoperative concomitant diseases were influential factors for the occurrence of complications (all P<0.05). Conclusion: Totally laparoscopic radical gastrectomy has the advantages of minor trauma and quick postoperative recovery, and also has better control of the overall complications than open surgery. So it is recommended to be used in clinical practice.
Keywords： Stomach neoplasms gastrectomy laparoscopes Postoperative Complications