三维腹腔镜保留脾脏贲门淋巴结清扫术治疗胃癌优于二维腹腔镜吗？一项前瞻性临床研究分析。
Is three-dimensional laparoscopic spleen preserving splenic hilar lymphadenectomy for gastric cancer better than that of two-dimensional? Analysis of a prospective clinical research study.
机构信息
Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
出版信息
Surg Endosc. 2019 Oct;33(10):3425-3435. doi: 10.1007/s00464-018-06640-7. Epub 2019 Feb 26.
BACKGROUND
Three-dimensional (3D) systems for laparoscopy provide surgeons with additional information on spatial depth not found in two-dimensional (2D) systems.
METHODS
This study enrolled 156 spleen-preserving splenic hilar lymphadenectomy (LSPSHL) patients in a randomized controlled trial (ClinicalTrials.gov Identifier NCT02327481) at the department of gastric surgery at Fujian Medical University Union Hospital between January 2015 and April 2016. The short-term efficacies were compared between the treatment groups. The unedited videos of 80 LSPSHL (40 procedures each for 3D and 2D) were rated for technical performance using the Generic Error Rating Tool.
RESULTS
The data for 156 LSPSHL patients indicate that the estimated blood loss (EBL) (3D vs 2D = 66.3 vs. 99.0, P = 0.046) was significantly less in the 3D group. The postoperative recovery and complication rates were similar (P > 0.05). And there were no deaths within 30 days of surgery. Two observers analyzed 80 videos of LSPSHL. The results showed that there were fewer grasping-errors made in the 3D group than in the 2D group when dissecting the inferior pole region of spleen (IPRS) (P = 0.016) and the superior pole region of spleen (SPRS) (P = 0.022). Additionally, the inter-rater reliability was high regarding grasping-errors in the IPRS (intraclass correlation coefficient (ICC) 0.92) and in the SPRS (ICC 0.83). The ICC for the total number of errors was 0.82. The mean of errors in the 3D group (3D vs. 2D = 20.7 vs. 23.5, P = 0.022) was less than the 2D group.
CONCLUSIONS
Compared with 2D LSPSHL, 3D technology reduces EBL and technical errors during splenic hilar dissection.
背景
与二维（2D）系统相比，三维（3D）系统为外科医生提供了更多关于空间深度的信息。
方法
本研究纳入了 2015 年 1 月至 2016 年 4 月期间福建医科大学附属协和医院胃外科部门进行的一项随机对照试验（ClinicalTrials.gov 标识符 NCT02327481）中的 156 例保留脾脏的脾门淋巴结清扫术（LSPSHL）患者。比较了两组的短期疗效。使用通用错误评分工具对 80 例 LSPSHL（3D 组和 2D 组各 40 例）的未编辑视频进行技术性能评分。
结果
156 例 LSPSHL 患者的数据表明，3D 组的估计出血量（EBL）（3D 比 2D=66.3 比 99.0，P=0.046）明显较少。术后恢复和并发症发生率相似（P>0.05）。并且在手术后 30 天内没有死亡。两名观察者分析了 80 例 LSPSHL 视频。结果表明，在解剖脾脏下极区域（IPRS）（P=0.016）和脾脏上极区域（SPRS）（P=0.022）时，3D 组的抓握错误少于 2D 组。此外，在 IPRS（组内相关系数（ICC）0.92）和 SPRS（ICC 0.83）中，抓握错误的观察者间可信度较高。总错误数的 ICC 为 0.82。3D 组的错误平均值（3D 比 2D=20.7 比 23.5，P=0.022）小于 2D 组。
结论
与 2D LSPSHL 相比，3D 技术减少了脾门解剖过程中的 EBL 和技术错误。
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