探讨3D腹腔镜近端胃癌根治术在直径>5 cm的T3-4期胃癌患者中的应用效果。

回顾性分析2019年1月至2020年6月3D腹腔镜近端胃癌根治术36例进展期胃癌患者(3D组)临床资料，选取同期接受2D腹腔镜近端胃癌根治术患者40例(2D组)进行比较。选用SPSS 22.0统计软件进行数据分析。脾门淋巴结清扫数目、清扫脾门淋巴结用时等计量资料以(±s)表示，采用独立样本t检验；并发症发生率等计数资料采用χ²检验。P<0.05为差异有统计学意义。

3D组手术时间、术中出血量、脾门淋巴结清扫数目、清扫脾门淋巴结时间、误伤脾脏发生率均小于2D组，差异有统计学意义(P<0.05)；两组患者均进行了脾门原位淋巴结清扫，术中未见完全脾脏梗死，3D组术中出现脾门区出血1例，脾脏局部梗死1例，误伤脾脏2例；2D组术中脾门区出血3例，脾脏局部梗死5例，误伤脾脏9例；两组术中脾门区出血、脾脏局部梗死比较无显著差异(P>0.05)，3D组误伤脾脏发生率显著低于2D组(P<0.05)；3D组并发症发生率8.3%，2D组并发症发生率15.0%，两组比较差异无统计学意义(P>0.05)；随访时间6~18个月，中位随访时间为9个月。3D组随访率100%，有1例复发，无死亡例数；2D组随访38例，有2例复发，1例死于肝转移，两组患者复发转移率和术后生存率比较差异无统计学意义(P>0.05)。

在近端胃癌根治术中，3D腹腔镜可缩短手术时间、减少术中出血量，脾门淋巴结清扫更彻底且降低脾脏损伤的可能性，其方式安全可靠，近期预后良好。

To investigate the effect of 3D laparoscopic proximal radical gastrectomy in patients with T3-4 gastric cancer >5 cm in diameter.

Clinical data of 36 patients with advanced gastric cancer receiving 3D laparoscopic radical proximal gastrectomy from January 2019 to June 2020 (3D group) were retrospectively analyzed, and 40 patients (2D group) receiving 2D laparoscopic radical proximal gastrectomy during the same period were selected. SPSS 22.00 statistical software was used for data analysis. Measurement data such as the number and time of splenic lymph nodes dissected were expressed as (±s). Independent sample t test was performed. The incidence of complications were tested by χ² test. P<0.05 was considered statistically significant.

The operative time, intraoperative blood loss, the number of splenic hilar lymph nodes dissection, the time of splenic hilar lymph nodes dissection and the incidence of accidental spleen injury in the 3D group were lower than those in the 2D group, with statistical significance (P<0.05). In both groups, there was no complete splenic infarction. In the 3D group, intraoperative splenic hilar hemorrhage occurred in 1 case, local splenic infarction in 1 case, and accidental injury to the spleen in 2 cases. In group 2D, there were 3 cases of splenic hilar hemorrhage, 5 cases of local splenic infarction, and 9 cases of accidental splenic injury. There were no significant differences in intraoperative splenic portal hemorrhage and local spleen infarction between the two groups (P>0.05). The incidence of accidental spleen injury in the 3D group was significantly lower than that in the 2D group (P<0.05). The incidence of complications was 8.3% in the 3D group and 15.0% in the 2D group, and there was no significant difference between the two groups (P>0.05). The follow-up time was 6 to 18 months, and the median follow-up time was 9 months. In the 3D group, the follow-up rate was 100%, with 1 recurrence and no death. In the follow-up of 38 patients in the 2D group, 2 patients recurred and 1 died of liver metastasis. There was no significant difference in the recurrence and metastasis rate and postoperative survival rate between the two groups (P>0.05).

In radical resection of proximal gastric cancer, 3D laparoscopy can shorten the operation time, reduce intraoperative blood loss, more complete splenic hilar lymph node dissection and reduce the possibility of spleen injury. The method is safe and reliable, and the prognosis is good in the near future.