本文選題：完全腹腔鏡　切入點(diǎn)：遠(yuǎn)端胃癌　出處：《新鄉(xiāng)醫(yī)學(xué)院》2015年碩士論文

【摘要】：背景胃癌是我國(guó)發(fā)病率最高的惡性腫瘤,而手術(shù)治療是胃癌治愈的首要手段。從腹腔鏡技術(shù)開(kāi)始運(yùn)用于胃癌手術(shù)治療發(fā)展至今,腹腔鏡輔助下遠(yuǎn)端胃癌根治術(shù)已在各地醫(yī)院得到了廣泛的開(kāi)展。而隨著微創(chuàng)理念的要求和各類(lèi)腔內(nèi)縫合器的產(chǎn)生,完全腹腔鏡遠(yuǎn)端胃癌根治術(shù)也在國(guó)內(nèi)少數(shù)醫(yī)療中心開(kāi)展。但其在國(guó)內(nèi)開(kāi)展較晚,尚處于探索階段,所以其能否達(dá)到腹腔鏡輔助的安全性、可行性及療效,能否確切的減少創(chuàng)傷、加速術(shù)后恢復(fù)、改善美容效果等,都值得進(jìn)一步探究。目的探究完全腹腔鏡遠(yuǎn)端胃癌根治術(shù)的安全性、根治性、美容效果及近期療效。方法本研究選取2013年12月至2015年2月間的70例在我科行遠(yuǎn)端胃癌D2根治術(shù)的患者,隨機(jī)分為A、B兩組。A組32例行TLDG(totally laparoscopic distal gastrectomy),即完全腹腔鏡遠(yuǎn)端胃癌根治術(shù),B組38例行LADG(laparoscopic-assisted distal gastrectomy),即腹腔鏡輔助遠(yuǎn)端胃癌根治術(shù)。通過(guò)對(duì)兩組患者間臨床資料及術(shù)中術(shù)后各項(xiàng)指標(biāo)的對(duì)比,探討的全腹腔鏡遠(yuǎn)端胃癌根治術(shù)的安全性和療效。結(jié)果在術(shù)中觀察指標(biāo)方面,A組手術(shù)時(shí)間為(221.5±25.7)min,B組手術(shù)時(shí)間為(216.2±28.8)min,差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.423)；A組手術(shù)切口長(zhǎng)度明顯短于B組(4.3±1.2) cm vs (6.2±1.6) cm,差異有統(tǒng)計(jì)學(xué)意義(P=0.000)；A組術(shù)中出血量明顯少于B組(115.4±32.7)ml vs(143.8±35.6)ml,差異有統(tǒng)計(jì)學(xué)意義(P=0.001)；A組淋巴結(jié)清掃個(gè)數(shù)為(21.7±4.5)枚,B組淋巴結(jié)清掃個(gè)數(shù)為(19.6±5.7)枚,兩組結(jié)果相比差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.096)；A組腫瘤上切緣長(zhǎng)度為(4.7±1.3)cm,B組腫瘤上切緣長(zhǎng)度為(4.3±1.1)cm,差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.168)；A組腫瘤下切緣長(zhǎng)度為(3.3±0.9)cm,B組腫瘤下切緣長(zhǎng)度為(3.1±1.0)cm,兩組結(jié)果相比差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.386)。在術(shù)后觀察指標(biāo)方面：A組術(shù)后首次排氣時(shí)間明顯短于B組(3.8±1.1)d vs(4.5±1.3)d,差異有統(tǒng)計(jì)學(xué)意義(P=0.019)；A組術(shù)后住院時(shí)間明顯短于B組(8.6±2.1)d vs(10.4±3.5)d,差異有統(tǒng)計(jì)學(xué)意義(P=0.013)。而兩組患者的出現(xiàn)術(shù)后并發(fā)癥發(fā)生率分別為15.6%和18.4%,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論此次研究結(jié)果顯示完全腹腔鏡下遠(yuǎn)端胃癌根治術(shù)有著與腹腔鏡輔助遠(yuǎn)端胃癌根治術(shù)相當(dāng)?shù)氖中g(shù)安全性、根治性及近期療效。而完全腹腔鏡遠(yuǎn)端胃癌根治術(shù)較之腹腔鏡輔助遠(yuǎn)端胃癌根治術(shù)具有更短的手術(shù)切口,美容效果也更為突出。同時(shí),與腹腔鏡輔助遠(yuǎn)端胃癌根治術(shù)相比,完全腹腔鏡遠(yuǎn)端胃癌根治術(shù)的手術(shù)創(chuàng)傷更小,在術(shù)后胃腸功能恢復(fù)方面更具優(yōu)勢(shì),更利于患者術(shù)后的快速康復(fù)。
[Abstract]:Background gastric cancer is the most common malignant tumor in China, and surgical treatment is the most important method for the cure of gastric cancer. Laparoscopic assisted radical resection of distal gastric cancer has been widely carried out in hospitals. However, with the requirement of minimally invasive principle and the emergence of various kinds of endovascular suture devices, Complete laparoscopic distal gastric cancer radical resection is also carried out in a few medical centers in China. However, it is still in the exploratory stage because of its late development in China, so whether it can achieve the safety, feasibility and efficacy of laparoscopy, and whether it can definitely reduce trauma. It is worth further study to accelerate postoperative recovery and improve cosmetic effect. Objective to explore the safety and efficacy of radical laparoscopic distal gastric cancer surgery. Methods from December 2013 to February 2015, 70 patients with distal gastric cancer underwent D2 radical resection in our department. Group A was randomly divided into two groups. Group A (32 cases) were treated with TLDG(totally laparoscopic distal gastrectomyn (group B), and group B (38 cases) with LADG(laparoscopic-assisted distal gastrectomycosis (group B). The clinical data and postoperative indexes were compared between the two groups. Results the operative time of group A was 221.5 鹵25.7 min and the operative time of group B was 216.2 鹵28.8min. There was no significant difference in the length of incision between group A and group B (P < 0. 423). The amount of intraoperative bleeding in group A was significantly lower than that in group B (115.4 鹵32.7)ml 鹵35.6ml), and the number of lymph nodes dissected in group A was 21.7 鹵4.5) and the number of lymph nodes dissected in group B was 19.6 鹵5.7mm. There was no significant difference between the two groups in the length of tumor superior incisor in group A (4.7 鹵1.3 cm) and in group B (4.3 鹵1.1 cm). There was no significant difference in the length of lower margin of tumor between group A and group A (3.3 鹵0.9 cm ~ (-1)), and the length of tumor margin in group B was 3.1 鹵1.0 cm ~ (-1) cm ~ (-1). There was no significant difference in postoperative parameters between two groups (P < 0.01). The postoperative first exhaust time in group A was significantly shorter than that in group B (3.8 鹵1.1 vs(4.5 鹵1.3 d), and the postoperative hospitalization time of group A was significantly shorter than that of group B (8.6 鹵2.1 days 鹵3.5 days), and the difference was statistically significant (P 0.013). The incidence of postoperative complications in the two groups was 15.6% and 18.4, respectively. There was no significant difference between the two groups (P 0.05). Conclusion the results of this study show that the total laparoscopic radical resection of distal gastric cancer is as safe as laparoscopic assisted radical gastrectomy of distal gastric cancer. Total laparoscopic distal gastric cancer radical resection has shorter incision and more prominent cosmetic effect than laparoscopic assisted distal gastric cancer radical resection. At the same time, compared with laparoscopic assisted distal gastric cancer radical mastectomy, total laparoscopic distal gastric cancer radical resection is more effective than laparoscopic assisted distal gastric cancer radical resection. Complete laparoscopic distal gastric cancer surgery has less trauma, more advantages in the recovery of gastrointestinal function, and is more conducive to the rapid recovery of postoperative patients.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R735.2

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