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中华腔镜外科杂志(电子版) ›› 2021, Vol. 14 ›› Issue (03) : 141 -148. doi: 10.3877/cma.j.issn.1674-6899.2021.03.003

论著

腹腔镜辅助和全腹腔镜远端胃癌根治术的短期疗效和生活质量的对比研究
胡鹏1, 梁文全2, 张珂诚2, 郗洪庆2, 崔建新2, 陈凛2,()   
  1. 1. 100853 北京,解放军医学院;100853 北京,解放军总医院第一医学中心普通外科医学部
    2. 100853 北京,解放军总医院第一医学中心普通外科医学部
  • 收稿日期:2021-04-23 出版日期:2021-08-18
  • 通信作者: 陈凛
  • 基金资助:
    北京市科技计划课题(D171100006517002;D171100006517004)

Short-term and quality of life outcomes of laparoscopy-assisted versus totally laparoscopic distal gastrectomy for gastric cancer: a single-center retrospective cohort study

Peng Hu1, Wenquan Liang2, Kecheng Zhang2, Hongqing Xi2, Jianxin Cui2, Lin Chen2,()   

  1. 1. Medical School of Chinese PLA, Beijing 100853, China.; Department of General Surgery, First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
    2. Department of General Surgery, First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
  • Received:2021-04-23 Published:2021-08-18
  • Corresponding author: Lin Chen
引用本文:

胡鹏, 梁文全, 张珂诚, 郗洪庆, 崔建新, 陈凛. 腹腔镜辅助和全腹腔镜远端胃癌根治术的短期疗效和生活质量的对比研究[J/OL]. 中华腔镜外科杂志(电子版), 2021, 14(03): 141-148.

Peng Hu, Wenquan Liang, Kecheng Zhang, Hongqing Xi, Jianxin Cui, Lin Chen. Short-term and quality of life outcomes of laparoscopy-assisted versus totally laparoscopic distal gastrectomy for gastric cancer: a single-center retrospective cohort study[J/OL]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2021, 14(03): 141-148.

目的

探究和比较腹腔镜远端胃切除术(laparoscopic -assisted distal gastrectomy, LADG)和全腔镜远端胃癌根治术(totally laparoscopic distal gastrectomy,TLDG)的短期疗效和术后1年生活质量差异。

方法

回顾性分析2017年1月至2020年1月接受腹腔镜远端胃癌根治术的98例胃癌患者,所有患者均行Billroth-Ⅱ+Braun消化道重建方式。其中接受LADG患者57例(LADG组),接受TLDG患者41例(TLDG组),收集并比较两组患者的基本资料、手术相关指标、术后恢复指标及相关并发症,通过QLQ-C30和QLQ-STO22量表联合评估术后1年两组患者的生活质量。

结果

两组患者基本资料比较,差异无统计学意义(P>0.05)。相比于LADG组,TLDG组的术中出血量更少、手术切口更短(P=0.035,P<0.010)。在术后恢复方面,TLDG组的首次排气时间、首次进食流食时间和术后住院时间均短于LADG组(P=0.033,P<0.010,P<0.010)。此外,TLDG组术后5 d血红蛋白水平显著高于LADG组(P=0.035,P=0.012,P<0.001),但两组患者术后并发症发生率比较,差异无统计学意义(P>0.05)。两组术后12个月TLDG组的总体健康状况评分显著高于LADG组(P=0.039),其余生活质量未见明显差异(P>0.05)。

结论

与LADG相比,TLDG术后恢复更快、术中出血量更少、手术切口更短、术后血红蛋白水平更高,且术后12个月患者总体健康状况更优,但其余生活质量和并发症发生率方面未展现显著优势。

Objective

To explore the differences of short-term outcomes and patients’ quality of life (QoL) between totally laparoscopic distal gastrectomy (TLDG) and laparoscopic-assisted distal gastrectomy (LADG).

Methods

The clinical data of 98 patients from Jan. 2017 to Jan. 2020 who underwent laparoscopic distal gastrectomy with Billroth-Ⅱ+ Braun reconstruction were retrospectively analyzed.They were divided into TLDG group (n=41) and LADG group (n=57). The clinical data and results of QoL questionnaires 6 months and 12 months after operation were compared between the two groups.

Results

The clinical characteristics and pathological data showed no significant difference between the two groups (P>0.05). Compared with the LADG group, the TLDG group had earlier time of first flatus, quicker return to a liquid diet and shorter postoperative hospital stay (P=0.033, P<0.010, P<0.010). Besides, in the LADG group, the blood loss was greater, the level of Hemoglobin was higher and the length of longest incision was longer as compared with the TLDG group(P=0.035, P=0.012, P<0.001). There were no significant differences in the morbidity of postoperative complications between two groups (P>0.05). As for the QoL, the global health status of TLDG group showed better score than that of LADG group at 12 months after surgery(P=0.039). Other function scales and symptom scales did not show any significant differences between the two groups(P>0.05).

Conclusions

Compared with LADG, TLDG permitted faster postoperative recovery, less intraoperative blood loss, shorter length of incision and higher level of hemoglobin after operation. It also permitted better global health status of patients at 12 months after surgery, but showed no superiority in the morbidity of postoperative complications as compared with LADG.

表1 腹腔镜远端胃癌根治术两组患者基本资料和病理资料比较
项目 LADG组(57例) TLDG组(41例) t/U/χ2 P
基本资料        
  年龄(岁,±s) 58.7±10.8 56.2±10.3 1.174 0.243
  性别[例(%)]     0.122 0.727
    37(64.9) 28(68.3)    
    20(35.1) 13(31.7)    
  体质量指数(kg/m2±s) 24.0±3.4 25.0±3.1 -1.562 0.122
  ASA分级[例(%)]       0.947
    1 34(59.6) 23(56.1)    
    2 19(33.3) 15(36.6)    
    3 4(7.0) 3(7.3)    
  ECOG评分[例(%)]     0.354 0.838
    0 23(40.4) 19(46.3)    
    1 26(45.6) 17(41.5)    
    2 8(14.0) 5(12.2)    
  合并症数量(个)     0.105 0.746
    0~1 40(70.2) 30(73.2)    
    ≥2 17(29.8) 11(26.8)    
病理资料        
  肿瘤部位[例(%)]     0.271 0.603
    胃中部 43(75.4) 29(70.7)    
    胃下部 14(24.6) 12(29.3)    
  分化程度[例(%)]     - 0.351
    高分化 5(8.8) 4(9.8)    
    中分化 28(49.1) 14(34.1)    
    低分化 24(42.1) 23(56.1)    
  T分期[例(%)]     - 0.228
    T1a 18(31.6) 10(24.4)    
    T1b 7(12.3) 10(24.4)    
    T2 8(14.0) 2(4.9)    
    T3 24(42.1) 19(46.3)    
  N分期[例(%)]     - 0.172
    N0 34(59.6) 25(61.0)    
    N1 8(14.0) 7(17.1)    
    N2 14(24.6) 5(12.2)    
    N3 1(1.8) 4(9.7)    
  TNM临床分期[例(%)]     - 0.097
    ⅠA 21(36.8) 19(46.3)    
    ⅠB 8(14.0) 2(4.9)    
    ⅡA 10(17.5) 7(17.1)    
    ⅡB 5(8.8) 4(9.8)    
    ⅢA 13(22.8) 5(12.2)    
    ⅢB 0(0.0) 4(9.7)    
  肿瘤大小(cm) 2.0(3.0~4.5) 2.5(1.5~4.0) 1 050.5 0.394
  转移淋巴结数目(枚) 0(0~4.0) 0(0~3.5) 1 137.5 0.799
表2 腹腔镜远端胃癌根治术两组患者手术相关和围手术期指标比较
表3 腹腔镜远端胃癌根治术两组患者术后早期和晚期并发症比较[例(%)]
表4 腹腔镜远端胃癌根治术两组患者术后6个月EORTC QLQ-C30评分比较(分)
表5 腹腔镜远端胃癌根治术两组患者术后12个月EORTC QLQ-C30评分比较(分)
表6 腹腔镜远端胃癌根治术两组患者术后6个月EORTC QLQ-STO22评分比较(分)
表7 腹腔镜远端胃癌根治术两组患者术后12个月EORTC QLQ-STO22评分比较(分)
1
Kitano S, Iso Y, Moriyama M, et al. Laparoscopy-assisted Billroth I gastrectomy[J]. Surg Laparoscopy Endoscopy,1994,4(2): 146-148.
2
黄昌明,黄泽宁.完全腹腔镜胃癌根治术后消化道重建的选择和操作要点[J/CD]. 中华腔镜外科杂志(电子版),2019,12(1): 34-36.
3
Choi C, Lee C, Park J, et al. Recent status of laparoscopic distal gastrectomy in korea: a multicenter retrospective cohort study (pre-study survey of KLASS-07 trial) [J]. Frontiers in oncology,2019,9: 982.
4
Li Zhengyan, Bai Bin, Ji Gang, et al, Relationship between clavien-dindo classification and long-term survival outcomes after curative resection for gastric cancer: a propensity score-matched analysis[J]. International journal of surgery (London, England), 2018,60: 67-73.
5
Kim Kwangsoon, Kim Jin Kyong, Lee Cho Rok, et al, Comparison of long-term prognosis for differentiated thyroid cancer according to the 7th and 8th editions of the AJCC/UICC TNM staging system[J]. Therapeutic advances in endocrinology and metabolism, 2020,11.
6
胡建昆,刘凯,杨昆. 4K腹腔镜近端胃癌根治术淋巴结清扫范围规范及技术标准解读[J]. 中华消化外科杂志,2020,19(1): 21-24.
7
许光中,杜德晓,李凯,等. 加速康复外科在腹腔镜袖状胃切除术围手术期的应用[J/CD]. 中华腔镜外科杂志(电子版),2019,12(2): 96-99.
8
黄泽宁,黄昌明,郑朝辉,等. 腹腔镜全胃切除术中Later-cut Overlap吻合与Roux-en-Y吻合的倾向评分匹配疗效分析[J]. 中华消化外科杂志,2020,19(9): 961-969.
9
Tanaka Chie, Kanda Mitsuro, Murotani Kenta, et al. Long-term quality of life and nutrition status of the aboral pouch reconstruction after total gastrectomy for gastric cancer: a prospective multicenter observational study (CCOG1505)[J]. Gastric cancer: official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association,2019,22(3): 607-616.
10
王胤奎,李子禹,陕飞,等. 腹腔镜下非离断式Roux-en-Y与BillrothⅡ-Braun消化道重建的安全性及卫生经济学比较——单中心前瞻性队列研究[J]. 中华胃肠外科杂志,2018,21(3): 312-317.
11
Kim J, Jun K, Chin H. Short-term surgical outcomes of laparoscopy-assisted versus totally laparoscopic Billroth-II gastrectomy for gastric cancer: a matched-cohort study[J]. BMC surgery,2017,17(1): 45-45.
12
Lin M, Zheng C, Huang C, et al. Totally laparoscopic versus laparoscopy-assisted Billroth-I anastomosis for gastric cancer: a case-control and case-matched study[J]. Surgical endoscopy,2016,30(12): 5245-5254.
13
单毓强,郑斯鑫,朱阿考,等. 完全腹腔镜根治性全胃切除术中淋巴结清扫和消化道重建应用总结[J/CD]. 中华腔镜外科杂志(电子版),2019,12(6): 342-346.
14
虞煜,张谋成,高楷峻,等. 加速康复外科在完全腹腔镜胃癌根治术中的应用[J]. 中华普通外科杂志,2020,35(1): 21-25.
15
Jang E, Kim M, Nam S. Risk factors for the development of incisional hernia in mini-laparotomy wounds following laparoscopic distal gastrectomy in patients with gastric cancer[J]. Journal of gastric cancer,2018,18(4): 392-399.
16
范昊,蔡军. 腹腔镜辅助远端胃癌根治术后胰瘘的相关影响因素分析[J]. 国际外科学杂志,2021,48(3): 170-174.
17
王淞,粟梅兰,邹中辉,等. 全腔镜与腔镜辅助胃癌全胃切除及食管空肠吻合术疗效差异Meta分析[J]. 国际外科学杂志,2020,47(4): 232-240,289.
18
Erawijantari Pande Putu, Mizutani Sayaka, Shiroma Hirotsugu, et al. Influence of gastrectomy for gastric cancer treatment on faecal microbiome and metabolome profiles[J]. Gut, 2020,69(8): 1404-1415.
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