南方医科大学学报

南方医科大学学报 ›› 2021, Vol. 41 ›› Issue (12): 1828-1834.doi: 10.12122/j.issn.1673-4254.2021.12.11

• • 上一篇    下一篇

加速康复外科模式下腹腔镜与开腹胃癌根治术的临床效果:基于中国多中心数据分析

张 越，季 刚，陶凯雄，梁 晖，雷三林，钟晓刚，王小忠，俞金龙，陈 超，赵景林，郑 权，王 强， 罗喻文，李 勇，王俊江   

  • 出版日期:2021-12-20 发布日期:2022-01-05

Application of laparoscopic and open gastrectomy in enhanced recovery after surgery for gastric cancer: analysis of data from multiple centers in China

ZHANG Yue, JI Gang, TAO Kaixiong, LIANG Hui, LEI Sanlin, ZHONG Xiaogang, WANG Xiaozhong, YU Jinlong, CHEN Chao, ZHAO Jinglin, ZHENG Quan, WANG Qiang, LUO Yuwen, LI Yong, WANG Junjiang   

  • Online:2021-12-20 Published:2022-01-05

RichHTML

21

PDF

550

摘要： 目的 比较加速康复外科（ERAS）模式下腹腔镜与开腹手术的治疗效果。 方法 对2015年1月~2017年12月国内12家医疗中心1569例接受胃癌根治术患者的临床病理资料进行回顾性研究分析，其中接受开腹手术患者共522例，腹腔镜手术患者共1004例，腹腔镜中转开腹患者共43例。比较腹腔镜组和开腹组患者术中相关指标及术后并发症等情况，主要研究终点是术后短期并发症发生率，次要研究终点是手术时间、术中出血量、淋巴结清扫数目、术后首次进食全流时间、首次排气时间、排便时间、下床活动时间、术后住院时间及出院后30 d内因并发症再入院情况等。 结果 1569例患者中，男性1037例（66.1%），女性532例 （33.9%），发病年龄58.4±11.3岁。近端胃切除术105例（6.7%），远端胃切除术877例（55.9%），全胃切除术587例（37.4%）。患者手术时间274.7±80.7 min，中位出血量为150（20~1300）mL，淋巴结清扫数目29.9±13.5枚。术后首次下床活动时间2.3±1.2 d，首次排气时间3.4±1.6 d，首次排便时间4.8±1.8 d，首次进食全流时间5.5±3.1 d，术后住院时间11.4±5.0 d。术后按Clavien-Dindo分 级≥Ⅱ级的并发症发生率为6.5%，术后30 d因并发症再入院率为1.1%。按手术方式分为腹腔镜组及开腹组（腹腔镜中转开腹病例归为开腹手术）。两组患者胃切除范围差异无统计学意义（P>0.05）；腹腔镜组淋巴结清扫数目多于开腹组，术中出血量、术后首次下床活动时间、进食全流时间、首次排气时间、排便时间和术后住院时间均少于开腹组（P<0.05）；腹腔镜组手术时间长于开腹组（P<0.05）；两组术后并发症差异无统计学意义（P>0.05）。 结论 腹腔镜手术应用于胃癌加速康复外科，相较于开腹手术能缩短术后首次下床活动、排气、排便、进食全流时间及术后住院时间，并可获得同样的肿瘤学根治效果，且不增加术后并发症的发生率。

关键词: 胃癌；加速康复外科；腹腔镜；并发症

Abstract: Objective To evaluate the clinical efficacy of laparoscopic and open gastrectomy in enhanced recovery after surgery (ERAS) for gastric cancer. Methods We retrospectively collected the clinicopathological data of gastric cancer patients undergoing radical gastrectomy at 12 Chinese medical centers between January, 2015 and December, 2017. We analyzed the clinical outcomes of a total of 1569 patients, including 552 patients undergoing open surgery, 1004 receiving laparoscopic surgery, and 43 experiencing conversion of laparoscopic surgery to open surgery. The operative outcomes and postoperative complications of the patients in laparoscopic group and open surgery group were analyzed. The primary outcome was the short-term postoperative complications. The secondary outcomes included operation time, estimated blood loss, number of lymph node dissection, time to first liquid diet intake, time to first passage of flatus and defecation, time to ambulation, postoperative hospitalization days and occurrence of readmission within 30 days. Results Of the total of 1569 patients, 1037 (66.1% ) were males and 532 (33.9% ) were females, with a mean age at diagnosis of 58.4±11.3 years. A total of 105 patients (6.7% ) underwent proximal gastrectomy, 877 (55.9% ) underwent distal gastrectomy, and 587 (37.4%) underwent total gastrectomy. In the overall patients, the operation time was 274.7±80.7 mins, blood loss was 150 (20-1300) mL, and the number of lymph nodes dissected was 29.9±13.5. The time to first ambulation, flatus, defecation and liquid food intake were 2.3±1.2, 3.4±1.6, 4.8±1.8 and 5.5±3.1 days, respectively. The postoperative hospital stay was 11.4±5.0 days. The incidence of postoperative complications (Clavien-Dindo score ≥II) was 6.5%, and the rate of readmission within 30 days after discharge was 1.1%. Subgroup analysis of the patients based on the surgical approach (conversion of laparoscopic surgery to open surgery was considered open surgery) showed no significant differences in the extent of gastrectomy between laparoscopic and open surgery groups (P>0.05). Compared with those in the open surgery group, the patients having laparoscopic gastrectomy had a greater number of lymph nodes retrieved with earlier ambulation, first flatus, defecation and oral intake and a shorter postoperative hospital stay (P<0.05). The laparoscopic group had a lower intraoperative blood loss but a longer operation time than the open surgery group (P<0.05). The incidence of postoperative complications did not differ significantly between the two groups (P>0.05). Conclusion Compared with open surgery, laparoscopic surgery in ERAS can shorten the time to ambulation, first flatus, defecation, and oral intake and the length of hospital stay. Laparoscopic surgery can achieve the same oncological outcomes as open surgery without increasing postoperative complications.

Key words: gastric cancer; enhanced recovery after surgery; laparoscopy; complications