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中华临床医师杂志(电子版)

中华临床医师杂志(电子版) ›› 2018, Vol. 12 ›› Issue (04) : 212 -217. doi: 10.3877/cma.j.issn.1674-0785.2018.04.005

所属专题： 文献；

胃肠道肿瘤

手助腹腔镜与开腹、腹腔镜辅助远端胃癌根治术的临床对比研究
张占学1,†(), 李忠1, 张海强1, 邱少凡1, 王海军1, 茹丽娜1, 王占文1, 李涛1   
  1. 1. 050000　石家庄，河北医科大学第二医院胃肠外科
  • 收稿日期:2018-01-19 出版日期:2018-02-15
  • 通信作者: 张占学

Clinical comparison of hand assisted laparoscopic gastrectomy with laparotomy and laparoscopy assisted radical gastrectomy for distal gastric cancer

Zhanxue Zhang1,†(), Zhong Li1, Haiqiang Zhang1, Shaofan Qiu1, Haijun Wang1, Lina Ru1, Zhanwen Wang1, Tao Li1   

  1. 1. Department of Gastroenterological Surgery, Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
  • Received:2018-01-19 Published:2018-02-15
  • Corresponding author: Zhanxue Zhang
  • About author:
    Corresponding author: Zhang Zhanxue, Email:
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张占学, 李忠, 张海强, 邱少凡, 王海军, 茹丽娜, 王占文, 李涛. 手助腹腔镜与开腹、腹腔镜辅助远端胃癌根治术的临床对比研究[J]. 中华临床医师杂志(电子版), 2018, 12(04): 212-217.

Zhanxue Zhang, Zhong Li, Haiqiang Zhang, Shaofan Qiu, Haijun Wang, Lina Ru, Zhanwen Wang, Tao Li. Clinical comparison of hand assisted laparoscopic gastrectomy with laparotomy and laparoscopy assisted radical gastrectomy for distal gastric cancer[J]. Chinese Journal of Clinicians(Electronic Edition), 2018, 12(04): 212-217.

目的

探讨手助腹腔镜在进展期远端胃癌根治术中的应用价值。

方法

回顾性分析河北医科大学第二医院2015年8月至2017年12月间80例进展期胃下部癌的临床资料，其中30例行手助腹腔镜手术，25例行开腹手术，25例行腹腔镜辅助手术。采用单因素方差分析比较3组之间手术时间、出血量、清扫淋巴结数目、术后排气时间、术后近期并发症、住院时间及住院费用、切口长度等指标的差异，组间的两两比较采用单因素方差分析中的Bonferroni方法。采用χ2检验或Fisher确切概率法比较3组间性别、病理类型、腹主动脉旁有肿大淋巴结、腹部手术史及术后并发症的差异。

结果

3种手术方式在术中淋巴结清扫数、术后住院费用及术后并发症方面比较，差异均无统计学意义（P>0.05）；手助腹腔镜手术组、腹腔镜辅助手术组和开腹手术组3种手术方式在手术时间［（186.30±15.27）min vs （230.80±17.06）min vs （183.36±16.03）min］、术中出血量［（93.33±46.86）ml vs（98.80±55.10）ml vs （246.80±92.90）ml］、术后排气时间［（2.3±0.6）d vs （2.42±0.44）d vs（3.04±0.56）d］、住院时间［（8.90±1.19）d vs （9.40±1.44）d vs（10.92±1.73）d］及切口长度［（7.97±0.49）cm vs （8.04±0.61）cm vs （24.04±2.11）cm］方面比较，差异均具有统计学意义（F=70.055，43.937，20.162，13.892，1385.430，P均<0.001）。手助腹腔镜手术组和腹腔镜辅助手术组切口长度、术中出血量、术后排气时间及住院时间方面<开腹手术组，差异具有统计学意义（P均<0.001）。手助腹腔镜手术组和开腹手术组在手术时间方面较腹腔镜辅助手术组更短，且差异具有统计学意义（P均<0.001）。

结论

手助腹腔镜进展期远端胃癌根治术安全可行，其在肿瘤切除及淋巴结清扫上可达到与开腹手术相当的效果，并且不增加患者经济负担。手助腹腔镜手术保留了腹腔镜辅助手术的术中出血少、术后恢复快的优点，且手术时间短。

关键词: 手助腹腔镜, 腹腔镜辅助, 传统开腹术, 进展期胃癌
Objective

To evaluate the value of hand assisted laparoscopic radical resection for distal gastric cancer.

Methods

The clinical data of 80 patients with advanced gastric cancer from August 2015 to December 2017 were retrospectively analyzed. Among them, 30 patients underwent hand-assisted laparoscopic surgery, 25 patients underwent open surgery, and 25 patients underwent laparoscopic assisted surgery. The operative time, bleeding volume, number of recected lymph nodes, time to postoperative exhaust, postoperative complications, length of hospitalization, hospitalization expenses, length of incision and so on were compared among the three groups. The data were analyzed with SPSS 21.0 software. Measurement data are expressed as mean±standard deviation. ANOVA was used to compare measurement data, and the chi square test or Fisher exact test was used to compare count data. P<0.05 indicated that the difference was statistically significant.

Results

There was no significant difference in the number of recected lymph nodes, postoperative hospitalization expenses, or postoperative complications among the three groups (P>0.05). The hand-assisted laparoscopic surgery group, laparoscopy assisted surgery group, and open surgery group had significantly different operative time [(186.30±15.27) min vs (230.80±17.06) min vs (183.36±16.03) min] , intraoperative bleeding volume [(93.33±46.86) mL vs (98.80±55.10) mL vs (246.80±92.90) mL] , time to postoperative exhaust [(2.3±0.6) d vs (2.42±0.44) d vs (3.04±0.56) d] , length of stay [(8.90±1.19) d vs (9.40±1.44) d vs (10.92±1.73) d] , and incision length [(7.97±0.49) cm vs (8.04±0.61) cm vs (24.04±2.11) cm] (P<0.001 for all). The length of incision, blood loss, time to postoperative exhaust, and hospital stay were significantly lower in the hand-assisted laparoscopic operation group and laparoscopically assisted operation group than in the open operation group (P<0.001). The operative time was significantly shorter in the hand-assisted laparoscopic surgery group and laparotomy group than in the laparoscopically assisted operation group (P<0.001).

Conclusion

Hand assisted laparoscopic distal gastrectomy is safe and feasible, can achieve the radical effect of open surgery for tumor resection and lymph node dissection, and does not increase the economic burden of patients. Hand assisted laparoscopic surgery has the advantages of less intraoperative bleeding, faster postoperative recovery, and shorter operative time than laparoscopic assisted surgery.

Key words: Hand assisted laparoscopy, Laparoscopy assisted, Traditional laparotomy, Advanced gastric cancer
图1 手助腹腔镜手术手助器及戳卡位置
图2 手助腹腔镜手术术中
图3 手助腹腔镜手术完成
表1 HALS组、OS组以及LAS组一般临床资料比较
组别 例数 性别（例，男/女） 年龄（岁，±s） 肿瘤大小（cm，±s） 病理类型（例，腺癌/印戒/黏液腺） 腹主动脉旁有肿大淋巴结（例） 腹部手术史（例）
HALS组 30 17/13 57.90±9.54 4.28±1.41 25/4/1 2 1
OS组 25 15/10 57.00±8.90 4.86±1.33 22/2/1 3 2
LAS组 25 14/11 58.56±7.59 4.12±1.42 21/2/2 1 1
统计值 ? χ2=0.095 F=0.200 F=1.992 - - -
P值 ? 0.953 0.820 0.143 0.883 0.667 0.828
表2 HALS组、OS组以及LAS组手术结果的比较
组别 例数 手术时间（h，±s） 出血量（ml，±s） 清扫淋巴结数（个，±s） 术后排气时间（d，±s） 术后并发症［例（%）］ 住院时间（d，±s） 住院费用（元，±s） 切口长度（cm，±s）
HALS组 30 186.30±15.27 93.33±46.86 24.73±2.46 2.30±0.6 2（6.6） 8.90±1.19 58174.77±7278.50 7.97±0.49
LAS组 25 230.80±17.06 98.80±55.10 27.8±6.9 2.24±0.41 3（12） 9.40±1.44 61572.48±5393.24 8.04±0.61
OS组 25 183.36±16.03 246.80±92.90 25.08±2.02 3.04±0.56 5（20） 10.92±1.73 56535.92±10326.71 24.04±2.11
F（χ2）值 ? 70.055 43.937 0.387 20.162 2.160 13.892 2.663 1385.430
P值 ? <0.001 <0.001 0.680 <0.001 0.369 <0.001 0.076 <0.001
Pa值 ? 0.777 <0.001 >0.05 <0.001 - <0.001 >0.05 <0.001
Pb值 ? <0.001 0.955 >0.05 0.387 - 0.450 >0.05 0.977
Pc值 ? <0.001 <0.001 >0.05 <0.001 - <0.001 >0.05 <0.001
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