CAJ | 학술논문

目的探讨右侧入路应用于腹腔镜胃癌根治术的可行性与安全性.方法回顾性分析2010年10月至2013年9月间在厦门大学附属第一医院肿瘤外科接受腹腔镜胃癌根治术治疗的178例患者的临床病理资料,其中右侧入路92例(右侧入路组),左侧入路86例(左侧入路组).比较两组患者的近期疗效及并发症发生率,并根据体质量指数进行分层分析.结果对于体质量指数大于或等于24 kg/m2的患者,右侧入路组(35例)较左侧入路组(31例)手术时间缩短[(227±17) min比(262±23) min],术中出血量减少[(73±9) ml比(84±8)ml],清扫的淋巴结数增多[(35±4)枚比(30±5)枚],术后镇痛药使用时间缩短[(2.1±0.1)d比(2.6±0.4)d],术后下床活动时间提早[(2.2±0.2)d比(2.8±0.6)d],肠功能恢复加快[(3.6±0.3)d比(4.2±0.5)d],差异均有统计学意义(均P＜0.05);但两组患者术后并发症发生率、术后住院时间及总住院费用的差异则无统计学意义(均P＞0.05).对于体质量指数小于24 kg/m2的患者,右侧入路组(57例)与左侧入路组(55例)上述指标的差异均无统计学意义(均P＞0.05).全组术后随访3～24个月,无一例肿瘤复发或死亡.结论右侧入路对于腹腔镜胃癌根治术是安全可行的,尤其是对于肥胖患者,右侧入路较左侧入路手术用时短、术中出血少、术后恢复快,且能清扫更多的淋巴结.
목적 탐토우측입로응용우복강경위암근치술적가행성여안전성.방법 회고성분석2010년10월지2013년9월간재하문대학부속제일의원종류외과접수복강경위암근치술치료적178례환자적림상병리자료,기중우측입로92례(우측입로조),좌측입로86례(좌측입로조).비교량조환자적근기료효급병발증발생솔,병근거체질량지수진행분층분석.결과 대우체질량지수대우혹등우24 kg/m2적환자,우측입로조(35례)교좌측입로조(31례)수술시간축단[(227±17) min비(262±23) min],술중출혈량감소[(73±9) ml비(84±8)ml],청소적림파결수증다[(35±4)매비(30±5)매],술후진통약사용시간축단[(2.1±0.1)d비(2.6±0.4)d],술후하상활동시간제조[(2.2±0.2)d비(2.8±0.6)d],장공능회복가쾌[(3.6±0.3)d비(4.2±0.5)d],차이균유통계학의의(균P＜0.05);단량조환자술후병발증발생솔、술후주원시간급총주원비용적차이칙무통계학의의(균P＞0.05).대우체질량지수소우24 kg/m2적환자,우측입로조(57례)여좌측입로조(55례)상술지표적차이균무통계학의의(균P＞0.05).전조술후수방3～24개월,무일례종류복발혹사망.결론 우측입로대우복강경위암근치술시안전가행적,우기시대우비반환자,우측입로교좌측입로수술용시단、술중출혈소、술후회복쾌,차능청소경다적림파결.
Objective To explore the technical feasibility,safety,and short-term clinical efficacy of right-to-lateral approach in laparoscopic-assisted radical gastrectomy.Methods Clinicopathological data of 178 gastric cancer patients undergoing laparoscopic-assisted radical gastrectomy,including 92 patients with right-to-lateral approach (R-LG group) and 86 cases with left-to-lateral approach (L-LG group),in our department from October 2010 to September 2013 were analyzed retrospectively.Short-term efficacy and complication morbidity were compared between R-LG group and L-LG group according to body mass index(BMI).Results For those patients with BMI≥24 kg/m2,the R-LG group (35 cases) had shorter mean operation time,less intraoperative blood loss,shorter painkiller used time than L-LG group(31 cases)[(227±17) min vs.(262±23) min,(73±9) ml vs.(84±8) ml and (2.1±0.1) d vs.(2.6±0.4) d,all P＜0.05].The average time to ambulation and recovery time of peristalsis in the R-LG group were faster than those in L-LG group [(2.2±0.2) d vs.(2.8±0.6) d and (3.6±0.3) d vs.(4.2± 0.5) d,all P＜0.05].The R-LG group had more dissected lymph nodes per patient (35±4) than the L-LG group (30±5) with significant difference (P＜0.05).There were no significances in postoperative hospital stay,postoperative complication morbidity and hospitalization expenses between R-LG and L-LG group (all P＞0.05).For those patients with BMI＜24 kg/m2,there were no significant differences in all above parameters between R-LG group(57 cases) and L-LG group(55 cases).No mortality and recurrence was observed during follow-up of 3 to 24 months.Conclusion Right-to-lateral approach in laparoscopicassisted radical gastrectomy is a safe and feasible procedure,especially for the obesity patients,which can shorten the operation time,decrease intraoperative blood loss,lead to a faster postoperative recovery and harvest more lymph nodes as compared to L-LG procedure.