[1]江恩来,王帅,杜广胜,等.单孔加一孔腹腔镜胃癌根治术后患者近期疗效分析[J].第三军医大学学报,2019,41(23):2348-3254.
 JIANG Enlai,WANG Shuai,DU Guangsheng,et al.Clinical efficacy of single-port plus one-port laparoscopic radical gastrectomy: a short-term analysis[J].J Third Mil Med Univ,2019,41(23):2348-3254.
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
41卷
期数:
2019年第23期
页码:
2348-3254
栏目:
临床医学
出版日期:
2019-12-15

文章信息/Info

Title:
Clinical efficacy of single-port plus one-port laparoscopic radical gastrectomy: a short-term analysis
作者:
江恩来王帅杜广胜邱远李云波肖卫东杨桦
400037 重庆,陆军军医大学(第三军医大学)第二附属医院普通外科
 
Author(s):
JIANG Enlai WANG Shuai DU Guangsheng QIU Yuan LI Yunbo XIAO Weidong YANG Hua

Department of General Surgery, Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, China

关键词:
加速康复外科胃癌SILS+1腹腔镜手术应激指标
Keywords:
enhanced recovery after surgery gastric cancer SILS +1 laparoscopic surgery stress indicators
分类号:
R181.32; R730.56; R735.2
文献标志码:
A
摘要:

目的探讨加速康复外科(enhanced recovery after surgery,ERAS)下单孔加一孔(single-port plus one-port,SILS+1)腹腔镜与传统五孔腹腔镜在胃癌根治术后患者近期疗效与应激指标比较。方法回顾性收集本院普通外科接受腹腔镜胃癌根治术患者114例的临床资料,按患者采取的手术方式分为SILS+1腹腔镜组(n=66)和传统五孔腹腔镜组(n=48)。2组患者均按照加速康复外科理念进行围手术期相关处理,SILS+1腹腔镜组患者采用单孔术式进行相关操作,传统五孔腹腔镜组采用传统五孔腹腔镜进行操作。记录并比较2组患者术后1、3、5 d的应激指标,包括白细胞计数(WBC)、C-反应蛋白(CRP)、血沉(ESR)、降钙素原(PCT)及白细胞介素6(IL-6)的水平,并比较2组患者手术时间、切口长度、术中出血量、肿瘤类型及TNM分期,记录患者术后胃管拔除时间、首次进食时间、首次下床活动时间、肛门首次排气时间、首次排便时间及术后住院时间。结果①2组患者年龄、性别、体质量指数及肿瘤分期差异无统计学意义(P>0.05),2组患者术前1 d的WBC、CRP、ESR、PCT及IL-6水平比较差异均无统计学意义(P>0.05);②SILS+1腹腔镜组的手术时间较传统五孔腹腔镜组长,差异有统计学意义(P<0.05);③术后1、3、5 d,SILS+1腹腔镜组的WBC、CRP、ESR、PCT及IL-6水平均明显低于传统五孔腹腔镜组(P<0.05);④SILS+1腹腔镜组患者的切口长度、首次肛门排气时间、术后首次排便时间及总住院时间均明显短于传统五孔腹腔镜组(P<0.05),2组患者胃管拔除时间、首次进食时间、首次下床活动时间比较差异无统计学意义(P>0.05)。结论在ERAS理念下,SILS+1腹腔镜较传统五孔腹腔镜手术时间有所延长,但能获得更好的近期临床疗效,且SILS+1腹腔镜有助于降低胃癌根治术后患者的应激反应,促进患者术后康复。

Abstract:

ObjectiveTo compare the short-term efficacy and stress indexes in patients after radical gastric cancer surgery between single-port plus one-port (SILS+1) laparoscope and traditional five-port laparoscope based on enhanced recovery after surgery (ERAS). MethodsA total of 114 patients who underwent laparoscopic radical gastrectomy in our department from March 2017 to July 2019 were recruited in this ERAS study. According the surgical approach, they were divided into SILS+1 group (n=66) and traditional laparoscopic group (n=48). The levels of white blood cell count (WBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalcitonin (PCT) and interleukin-6 (IL-6) at 1, 3 and 5 d after surgery were recorded and compared between the 2 groups. What’s more, operation time, incision length, intraoperative blood loss, tumor type and TNM stage were compared between the 2 groups, and the time of gastric tube removal, time of first feeding, time of first movement out of bed, time of first anal exhaust, time of first defecation and time of postoperative hospitalization were recorded. Results① There were no statistically significant differences in age, sex, BMI and tumor stage, or in WBC, CRP, ESR, PCT and IL-6 levels in 1 d before surgery between the 2 groups (P>0.05). ② The SILS+1 laparoscopic group had significantly longer operation time than the traditional laparoscopic group (P<0.05). ③ The WBC, CRP, ESR, PCT and IL-6 levels at 1, 3 and 5 d after surgery were significantly lower in the SILS+1 laparoscopic group than the traditional group (P<0.05). ④ The incision length, first anal exhaust time, first postoperative defecation time and total hospital stay were significantly shorter in the laparoscopic SILS+1 group than the traditional group (P<0.05). There were no statistical differences in the time of gastric tube removal, time of first feeding and time of first getting out of bed between them (P>0.05). ConclusionUnder the concept of ERAS, although SILS+1 laparoscope prolongs the operation time when compared with the traditional five-port laparoscope, it can obtain better short-term clinical efficacy, and is helpful to reduce the stress responses and promote the early recovery in the patients after radical gastric cancer surgery.

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更新日期/Last Update: 2019-12-09