3D腹腔镜残胃癌切除术的临床疗效
Clinical efficacy of three-dimensional laparoscopic resection for gastric stump cancer
目的 探讨3D腹腔镜残胃癌切除术的临床疗效.方法 采用回顾性横断面研究方法.收集2015年1月至2018年1月河南省人民医院收治的20例行3D腹腔镜残胃癌手术患者的临床病理资料.20例患者术前残胃肿瘤均经胃镜及病理学检查确诊为恶性肿瘤.患者均按日本胃癌协会第14版《胃癌处理规约》进行淋巴结清扫和施行残胃癌切除术.观察指标:(1)术中及术后恢复情况.(2)随访及生存情况.采用门诊和电话方式进行随访,了解患者术后生存及肿瘤复发情况.随访时间截至2018年3月.正态分布的计量资料以(-x)±s表示.偏态分布的计量资料采用M(范围)表示.结果 (1)术中及术后恢复情况:20例残胃癌患者中,行3D腹腔镜根治性残胃切除术14例(残胃标本为R0切除、镜下切缘阴性),行3D腹腔镜姑息残胃切除术4例,中转开腹行姑息残胃切除术2例.18例行3D腹腔镜残胃癌手术患者,手术时间为(195±60) min,术中出血量为(105±85) mL,淋巴结清扫数目为(20±8)枚;术后下床活动时间为(1.6±0.8)d,术后肛门首次排气时间为(3.0±1.0)d,术后进食半流质饮食时间为(5.5±1.8)d,术后住院时间为(8.0±2.8)d,治疗费用为(5.5±1.5)万元;术后未出现手术相关并发症.(2)随访及生存情况:20例患者中,18例获得随访,随访时间为2~36个月,中位随访时间18个月;随访期间6例死亡(2例因肝脏转移死亡、4例因腹膜转移死亡),12例一般情况良好.结论 3D腹腔镜残胃癌切除术是治疗残胃癌的一种安全、有效手术方式.
更多Objective To investigate the clinical efficacy of three-dimensional (3D) laparoscopic resection for gastric stump cancer.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 20 patients who underwent 3D laparoscopic resection for gastric stump cancer in the Henan Provincial People's Hospital between January 2015 and January 2018 were collected.All patients were diagnosed as malignant tumors through gastroscopy and pathological examination before operation,and underwent 3D laparoscopic resection for gastric stump cancer and lymph node dissection according to Japanese Classification of Gastric Carcinoma (ver.14).Observation indicators:(1) intra-and post-operative recovery situations;(2) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival and tumor recurrence up to March 2018.Measurement data with normal distribution were represented as (-x)±s.Measurement data with skewed distribution were described as M (range).Results (1) Intra-and post-operative recovery situations:of 20 patients with gastric stump cancer,14 underwent 3D laparoscopic radical resection for gastric stump cancer (R0 resection and negative resection margin),4 underwent 3D laparoscopic palliative resection for gastric stump cancer and 2 were converted to open palliative resection for gastric stump cancer.Operation time,volume of intraoperative blood loss,number of lymph node dissected,time for postoperative out-of-bed activity,time to initial anal exsufflation,time for postoperative semi-fluid diet intake,duration of hospital stay and treatment expenses in 18 patients were (195±60) minutes,(105±85) mL,20±8,(1.6±0.8) days,(3.0±1.0) days,(5.5±1.8)days,(8.0±2.8) days and (5.5± 1.5) ×104 yuan,respectively.There was no surgery-related complication.(2) Follow-up and survival situations:of 20 patients,18 were followed up for 2-36 months,with a median time of 18 months.During the follow-up,6 patients died,including 2 dying of liver metastases and 4 dying of peritoneal metastases,12 had good conditions.Conclusion 3D laparoscopic resection for gastric stump cancer is safe and effective.
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