目的:探讨3D腹腔镜胃癌D2根治术治疗进展期胃癌的围术期疗效。方法:回顾性分析我科2016年1月至2018年12月,181例进展期胃癌行胃癌D2根治术的临床资料,其中3D腹腔镜手术87例(3D组),开腹手术94例（开腹组）。比较两组围术期指标。结果:3D组无中转开腹。所有病例均为R0切除。围术期无死亡病例。两组手术时间、术后住院时间、术后并发症发生率差异均无统计学意义（P>0.05）。3D组术中出血量（155.06±144.95） mL少于开腹组（214.47±220.58） mL,两组差异有统计学意义（P=0.035）。3D组术后首次排气时间早于开腹组,两组差异有统计学意义（P=0.004）。术后进流质和半流质的开始时间,3D组亦早于开腹组,两者差异有统计学意义（P<0.05）。3D组淋巴结清扫数与开腹组相比,差异无统计学意义（P>0.05）。结论:3D腹腔镜胃癌D2根治术治疗进展期胃癌是一种安全可行、创伤小、恢复快的手术方式。
Objective To investigate the perioperative efficacy of 3D laparoscopic D2 radical gastrectomy in the treatment of advanced gastric cancer. Methods We analyze retrospectively 181 cases with advanced gastric cancer undergoing D2 radical gastrectomy in our department from January 2016 to December 2018 including 87 cases of 3D laparoscopic gastrectomy (3D group) and 94 cases of open gastrectomy (open group). The perioperative data were compared between two groups. Results There was no case in 3D group conversion to open. R0 dissection was gotten all in this study. No perio-perative mortality was found. There was no significant difference in operative time, postoperative hospital stay and postope-rative complications between two groups (P>0.05). The intraoperative blood loss in 3D group (155.06±144.95) mL was significantly less than that in open group (214.47±220.58) mL (P=0.035). Postoperative pass gas time, the time in taking li-quid food and semi-liquid food were all earlier in 3D group than those in open group significantly (P=0.004, P<0.05). No significant difference was present in lymph node dissection between two groups (P>0.05). Conclusions 3D laparoscopic D2 radical gastrectomy could be a safe and feasible surgical type for advanced gastric cancer with quicker recovery and minimal injury.
[1] Bray F, Ferlay J, Soerjomataram I, et al.Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin,2018,68(6):394-424.
[2] Chen W, Zheng R, Baade PD, et al.Cancer statistics in China, 2015[J]. CA Cancer J Clin,2016,66(2):115-132.
[3] 陈海金, 俞金龙, 黄宗海, 等. 3D高清腹腔镜在腹腔镜胃癌根治术中的应用[J]. 南方医科大学学报,2014,34(4):588-590.
[4] Sørensen SMD, Konge L, Bjerrum F.3D vision accele-rates laparoscopic proficiency and skills are transferable to 2D conditions: A randomized trial[J]. Am J Surg,2017, 214(1):63-68.
[5] Honeck P, Wendt-Nordahl G, Rassweiler J, et al.Three-dimensional laparoscopic imaging improves surgical performance on standardized ex-vivo laparoscopic tasks[J]. J Endourol,2012,26(8):1085-1088.
[6] Goh PM, Khan AZ, So JB, et al.Early experience with laparoscopic radical gastrectomy for advanced gastric cancer[J]. Surg Laparosc Endosc Percutan Tech,2001,11(2):83-87.
[7] 李敏哲, 沈荐, 杜燕夫, 等. 进展期胃癌腹腔镜辅助与开腹全胃D2根治术临床疗效的比较[J]. 中国微创外科杂志,2017,17(7):589-593.
[8] Lu J, Zheng CH, Zheng HL, et al.Randomized, controlled trial comparing clinical outcomes of 3D and 2D laparoscopic surgery for gastric cancer: an interim report[J]. Surg Endosc,2017,31(7):2939-2945.
[9] 葛思堂, 郝博, 陈德利,等. 三维腹腔镜系统在腹腔镜胃癌根治术中的应用[J]. 中华腔镜外科杂志,2017,10(1):53-56.
[10] 马君俊, 张鲁阳, 臧潞, 等. 腹腔镜T4a期胃癌根治术的远期疗效及预后因素分析[J]. 中华消化外科杂志,2017,16(12):1210-1216.
[11] Brennan MF.Current status of surgery for gastric cancer: a review[J]. Gastric Cancer,2005,8(2):64-70.
[12] 林建贤, 黄昌明, 郑朝辉, 等. 腹腔镜与传统开腹远端胃大部切除术治疗局部进展期胃癌的疗效对比研究[J]. 中华外科杂志,2016,54(10):755-760.
[13] Chan BYO, Yau KKW, Chan CKO.Totally laparoscopic versus open gastrectomy for advanced gastric cancer: a matched retrospective cohort study[J]. Hong Kong Med J,2019,25(1):30-37.
[14] 白军伟, 张超, 薛焕洲. 3D腹腔镜胃癌根治术的临床疗效[J]. 中华消化外科杂志,2017,16(3):257-261.
[15] Hu Y, Huang C, Sun Y, et al.Morbidity and mortality of laparoscopic versus open D2 distal gastrectomy for advanced gastric cancer: A randomized controlled trial[J]. J Clin Oncol,2016,34(2):1350-1357.
[16] Parisi A, Reim D, Borghi F, et al.Minimally invasive surgery for gastric cancer: A comparison between robotic, laparoscopic and open surgery[J]. World J Gastroenterol,2017,23(13):2376-2384.
[17] Zmora O, Gervaz P, Wexner SD.Trocar site recurrence in laparoscopic surgery for colorectal cancer[J]. Surg Endosc,2001,15(8):788-793.
[18] Zanghi A, Cavallaro A, Piccolo G, et al.Dissemination metastasis after laparoscopic colorectal surgery versus conventional open surgery for colorectal cancer: a me-tanalysis[J]. Eur Rev Med Pharmacol Sci,2013,17(9):1174-1184.
[19] Yu J, Huang C, Sun Y, et al.Effect of laparoscopic vs open distal gastrectomy on 3-year disease-free survival in patients with locally advanced gastric cancer: the CLASS-01 randomized clinical trial[J]. JAMA,2019,321(20):1983-1992.
[20] 陈小勋, 黄顺荣, 张兆明, 等. 进展期胃癌腹腔镜根治切除的临床经验[J]. 中华普通外科杂志,2013,28(6):413-416.
[21] 李政焰, 刘伟, 季刚, 等. 腹腔镜与开腹进展期胃癌D2根治术远期疗效的meta分析[J]. 国际外科学杂志,2017,44(2):88-94.
