摘要目的 分析全腹腔镜远端胃癌根治术( TLDG)临床应用的安全性、可行性和短期临床疗效.方法 收集2015年8月至2018年4月在中国医学科学院肿瘤医院胰胃外科行腹腔镜远端胃癌根治术的75例患者的临床资料,根据手术方式将患者分为TLDG组(29例),腹腔镜辅助远端胃癌根治术(LADG)组(46例),分析两组患者的近期疗效和安全性.结果 TLDG组患者的手术时间为(207±41)min,明显长于LADG组(156±34) min( P＜0.001). TLDG组患者的手术切口长度为( 3.6± 0.6)cm,明显短于LADG组[(5.8±0.8)cm,P＜0.001]. TLDG组患者的首次排气时间为(3.3±0.6)d,明显短于LADG组[(3.7±0.8)d,P＝0.034]. TLDG组和LADG组患者的术中出血量、术中是否输血、拔除胃管时间、拔除引流管时间、首次进食半流食时间、术后住院天数和术后并发症的发生率差异均无统计学意义(均P＜0.05). TLDG组和LADG组患者的手术获取淋巴结数、肿瘤距离近端切缘的距离、肿瘤距离远端切缘的距离差异均无统计学意义(均P＜0.05). TLDG组患者术后第1天血白细胞计数为(10.96±1.96)×109／L,明显低于LADG组[(12.49±3.46)×109／L,P＝0.017];术后第1天血清C反应蛋白的水平低于 LADG组,但差异无统计学意义( P＝0.072).结论 TLDG 是安全、可行的.TLDG具有切口小,术后胃肠功能恢复快,术后炎症反应轻等优点.

abstractsObjective To assess the safety, feasibility and short?term outcome of totally laparoscopic distal gastrectomy(TLDG). Methods Seventy?five patients who underwent laparoscopic distal gastrectomy in Cancer Hospital of Chinese Academy of Medical Science between August 2015 and April 2018 were enrolled in this study. A total of 46 laparoscopy?assisted distal gastrectomy ( LADG) cases and 29 TLDG cases were included. The Short?term outcomes and safeties of the two groups were compared. Results The operation time of TLDG group was significantly longer than that of LADG group (207±41 vs. 156± 34 min, P＜0.001), while the length of wound was shorter in the TLDG group (3.6±0.6 vs. 5.8±0.8 cm, P＜0.001). The time to first flatus in TLDG group was (3.3±0.6) days, significantly shorter than (3.7±0.8) days in LADG group ( P＝0.034). There were no significant differences between the two groups in the estimated blood loss, intraoperative blood transfusion, extraction of gastric tube, drainage tube removal, interval of the first time to eat semi?liquid food, postoperative hospital stays, surgical complications, number of retrieved lymph nodes, proximal and distal resection margin lengths ( all P＞0.05). The white blood cell count at postoperative day 1 in the TLDG group was (10.96±1.96)×109／L, significantly lower than (12.49± 3.46)×109／L of the LADG group ( P＝0.017).While the CRP level at postoperative day 1 in the TLDG group were lower than that of LADG group, no statistical difference was observed (P＝0.072). Conclusions Our study shows that TLDG is safe and feasible. TLDG has better cosmesis, less blood loss, and faster recovery compared to LADG.