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中华普外科手术学杂志(电子版)

中华普外科手术学杂志(电子版) ›› 2021, Vol. 15 ›› Issue (06) : 653 -656. doi: 10.3877/cma.j.issn.1674-3946.2021.06.019

论著

单孔+1孔腹腔镜远端胃癌根治术的安全性评价
马博1,†(), 周军2, 李建刚1, 王俊1   
  1. 1. 830063　新疆，新疆医科大学第二附属医院
    2. 510120　广州，中山大学附属孙逸仙纪念医院胃肠外科
  • 收稿日期:2020-10-29 出版日期:2021-12-26
  • 通信作者: 马博

Safety evaluation of single incision plus one port laparoscopic radical gastrectomy for distal gastric cancer

Bo Ma1,†(), Jun Zhou2, Jiangang Li1, Jun Wang1   

  1. 1. Second Affiliated Hospital of Xinjiang Medical University, Xinjiang 830063, China
    2. Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University stomach enterochirurgia, Guangzhou 510120, China
  • Received:2020-10-29 Published:2021-12-26
  • Corresponding author: Bo Ma
  • Supported by:
    Natural Science Foundation of Xinjiang Uygur Autonomous Region(2019D02C256); Hospital Project of the Second Affiliated Hospital of Xinjiang Medical University(20190215); Scientific Research Projects of Guangdong Science and Technology Department(2018ZC0181)
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马博, 周军, 李建刚, 王俊. 单孔+1孔腹腔镜远端胃癌根治术的安全性评价[J]. 中华普外科手术学杂志(电子版), 2021, 15(06): 653-656.

Bo Ma, Jun Zhou, Jiangang Li, Jun Wang. Safety evaluation of single incision plus one port laparoscopic radical gastrectomy for distal gastric cancer[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2021, 15(06): 653-656.

目的

研究单孔+1孔(SILS+1)腹腔镜远端胃癌根治术的安全性及可行性。

方法

回顾性分析2019年1月至2019年12月收治的SILS+1腹腔镜远端胃癌根治术患者临床资料41例，设为SILS+1组；纳入2018年1月至12月行五孔腹腔镜远端胃癌根治术患者临床资料68例进行比较，设为五孔组。使用统计学软件SPSS 24.0进行数据分析，手术相关指标、疼痛VAS评分等计量资料采用(±s)表示，组间比较采用独立样本t检验；术后并发症等计数资料采用χ2检验。以P<0.05差异有统计学意义。

结果

SILS+1组手术时间较五孔组略长，腹腔引流管拔除时间及住院时间均较五孔组短，差异均有统计学意义(P<0.05)。SILS+1组术后并发症总发生率为4.9%，五孔组总发生率为5.9%，差异无统计学意义(P>0.05)。SILS+1组术后12 h、1 d、2 d、3 d的VAS评分明显低于五孔组，差异均有统计学意义(P<0.05)。

结论

与五孔法相比，临床在掌握丰富的腹腔镜操作技术下，开展SILS+1腹腔镜远端胃癌根治术安全可行。

关键词: 胃肿瘤, 腹腔镜, 胃切除术, 安全, 单孔+1孔
Objective

To investigate the safety and feasibility of single-port + 1-port (SILS+ 1) laparoscopic radical resection of distal gastric cancer.

Methods

Clinical data of 41 patients with SILS+ 1 laparoscopic radical resection of distal gastric cancer admitted from January 2019 to December 2019 were retrospectively analyzed, who were assigned to the SILS+ 1 group. Clinical data of 68 patients who received five-hole laparoscopic radical resection of distal gastric cancer from January to December 2018 were included for comparison, and they were assigned to the five-hole group. Statistical software SPSS 24.0 was used for data analysis, operation related indicators, VAS score and other measurement data were expressed by (±s), independent sample t-test was used for comparison between groups. Postoperative complications were tested by χ2 test. P<0.05 was statistically significant.

Results

The operation time of the SILS+ 1 group was slightly longer than that of the Five hole group, postoperative abdominal drainage tube extraction time and hospitalization time were shorter than those of the Five hole group, and the differences between the two groups were statistically significant (P<0.05); There were no significant differences in intraoperative blood loss, number of lymph node dissection and hospitalization cost between 2 groups (P>0.05). The total incidence of postoperative complications was 4.9% in the SILS+ 1 group and 5.9% in the Five hole group group. The VAS scores of SILS+ 1 group at 12 h, 1 d, 2 d and 3 d after surgery were significantly lower than those of the five-well group, with statistical significance (P<0.05).

Conclusion

Compared with the five-hole method, it is safe and feasible to perform SILS+ 1 laparoscopic radical resection of distal gastric cancer under abundant laparoscopic operation techniques.

Key words: Stomach neoplasms, Laparoscopes, Gastrectomy, Safety, Single-port plus one-port
表1 109例远端胃癌不同腹腔镜术式两组患者一般临床资料比较[(±s)，例]
组别 例数 年龄(岁) 性别 BMI(kg/m2)
(男/女)
SILS+1组 41 57.3±11.4 26/15 23.1±3.8
五孔组 68 56.9±11.7 42/26 22.7±3.6
Z/t/χ2   0.174 0.634 0.550
P   0.430 0.617 0.291
组别 例数 肿瘤直径(cm) TNM分期
Ⅰ/Ⅱ/Ⅲ
SILS+1组 41 2.7±1.0 16/13/12
五孔组 68 2.8±1.0 21/31/16
Z/t/χ2   0.505 2.048
P   0.307 0.359
表2 109例远端胃癌不同腹腔镜术式两组患者围手术期指标比较(±s)
组别 例数 手术时间(min) 术中出血量(ml) 淋巴结清扫数目(枚)
SILS+1组 41 171.2±32.5 82.4±11.6 28.8±5.1
五孔组 68 152.6±28.4 86.8±14.5 29.1±5.3
t   3.135 1.649 0.290
P   0.001 0.050 0.386
组别 例数 术后首次排气时间(d) 腹腔引流管拔除时间(d) 住院时间(d) 住院费用(万)
SILS+1组 41 1.9±0.8 4.7±0.7 6.2±1.0 2.8±0.6
五孔组 68 2.1±1.0 5.6±0.9 8.6±1.2 3.2±0.8
t   1.087 5.478 6.269 1.583
P   0.139 0.000 0.000 0.053
表3 109例远端胃癌不同腹腔镜术式两组患者术后并发症发生情况比较(例)
组别 例 吻合口出血 吻合口漏 胃瘫 腹腔感染 胰瘘 总发生率(%)
SILS+1组 41 0 0 1 0 1 2(4.9)
五孔组 68 1 0 1 1 1 4(5.9)
χ2             0.044
P             0.833
表4 109例远端胃癌不同腹腔镜术式两组患者术后疼痛VAS评分比较(±s)
组别 例数 术后12 h 术后1 d 术后2 d 术后3 d
SILS+1组 41 2.5±0.5 2.0±0.5 1.7±0.4 1.3±0.3
五孔组 68 2.9±0.7 2.4±0.6 2.1±0.5 1.7±0.4
t   2.474 2.553 2.762 2.941
P   0.041 0.038 0.001 0.000
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