经脐单孔腹腔镜胆囊切除术治疗胆囊结石的临床疗效观察

Short-term outcomes of reduced-port laparoscopic surgery versus conventional laparoscopic surgery for total gastrectomy: a single-institute experience.

机构信息

Department of Gastrointestinal Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350014, China.

Department of Blood Transfusion, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350014, China.

出版信息

BMC Surg. 2023 Mar 30;23(1):75. doi: 10.1186/s12893-023-01972-1.

DOI:10.1186/s12893-023-01972-1

PMID:36997904

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10061835/

Abstract

BACKGROUND

The efficacy of reduced-port laparoscopic surgery (RLS) for total gastrectomy remains unclear. This study focused on evaluating the short-term outcomes of RLS compared with conventional laparoscopic surgery (CLS) for total gastrectomy.

METHODS

One hundred and ten patients who underwent completed laparoscopic total gastrectomy for gastric cancer between September 2018 and June 2022 were retrospectively collected and classified into two groups (65 CLS and 45 RLS) according to different operation approach. Twenty-four RLS cases underwent single-incision plus two ports laparoscopic surgery (SILS + 2) and twenty-one underwent single-incision plus one port laparoscopic surgery (SILS + 1). Surgical outcomes, pain intensity, cosmetic and postoperative morbidity, and mortality were compared between groups.

RESULTS

The overall incidence of postoperative complications was similar between the CLS group and the RLS group (16.9% vs. 8.9%, P = 0.270). It was also comparable in the Clavien-Dindo classification (P = 0.774). However, compared with the CLS group, the RLS group had a significantly shorter total length of incision (5.6 ± 1.0 cm vs. 7.1 ± 0.7 cm, P = 0.000); shorter time to first ambulation (24.9 ± 5.9 h vs. 27.6 ± 5.0 h, P = 0.009), flatus (3.0 ± 0.8 d vs. 3.5 ± 1.0 d, P = 0.022) and oral intake (4.0 ± 1.6 d vs. 6.1 ± 5.1 d, P = 0.011); lower white blood cell count on the third day after the operation (9.8 ± 4.010/L vs. 11.6 ± 4.710/L, P = 0.037); and lower visual analogue scale score on postoperative days 1 and 3(3.0 ± 0.7 vs. 3.3 ± 0.7, P = 0.044 and 0.6 ± 0.7 vs. 1.6 ± 0.6, P = 0.000 respectively). On the other hand, it didn't find any difference in short-term outcomes between the SILS + 2 group and the SILS + 1 group (P > 0.05). But the proximal resection margin was longer in the SILS + 2 group than in the SILS + 1 group (2.6 ± 0.7 cm vs. 1.5 ± 0.9 cm, P = 0.046) in patients with adenocarcinoma of the esophagogastric junction (AEG).

CONCLUSIONS

RLS for total gastrectomy is a feasible and safe technique when performed by an experienced laparoscopic surgeon. Moreover, compared with SILS + 1, SILS + 2 might have some advantages in AEG patients.

摘要

背景

经腹腔镜行全胃切除术（RLS）的疗效仍不清楚。本研究旨在评估 RLS 与传统腹腔镜手术（CLS）治疗全胃切除术的短期疗效。

方法

收集 2018 年 9 月至 2022 年 6 月期间因胃癌行腹腔镜全胃切除术的 110 例患者，根据不同手术方式分为两组（65 例 CLS 和 45 例 RLS）。24 例行单切口加两孔腹腔镜手术（SILS+2），21 例行单切口加单孔腹腔镜手术（SILS+1）。比较两组患者的手术结果、疼痛强度、美容及术后并发症发生率和死亡率。

结果

CLS 组和 RLS 组术后并发症总发生率无统计学差异（16.9% vs. 8.9%，P=0.270）。Clavien-Dindo 分级也无统计学差异（P=0.774）。然而，与 CLS 组相比，RLS 组的总切口长度更短（5.6±1.0 cm vs. 7.1±0.7 cm，P=0.000）；首次下床活动时间更短（24.9±5.9 h vs. 27.6±5.0 h，P=0.009）、排气时间（3.0±0.8 d vs. 3.5±1.0 d，P=0.022）和进食时间（4.0±1.6 d vs. 6.1±5.1 d，P=0.011）；术后第 3 天白细胞计数较低（9.8±4.010/L vs. 11.6±4.710/L，P=0.037）；术后第 1 天和第 3 天视觉模拟评分较低（3.0±0.7 vs. 3.3±0.7，P=0.044 和 0.6±0.7 vs. 1.6±0.6，P=0.000）。另一方面，SILS+2 组和 SILS+1 组之间的短期结果无统计学差异（P>0.05）。但在食管胃结合部腺癌（AEG）患者中，SILS+2 组近端切缘较 SILS+1 组长（2.6±0.7 cm vs. 1.5±0.9 cm，P=0.046）。