本文選題：腹腔鏡手術(shù) + 胃癌　； 參考：《鄭州大學(xué)》2016年博士論文

【摘要】：目的研究腹腔鏡技術(shù)在胃癌手術(shù)中的應(yīng)用及臨床療效。材料與方法提取2012年12月至2015年12月在鄭州大學(xué)人民醫(yī)院普外科行腹腔鏡胃癌根治術(shù)與同期開腹胃癌根治術(shù)患者的臨床資料,總結(jié)腹腔鏡技術(shù)在胃癌根治術(shù)中的的安全性,分析腹腔鏡技術(shù)在肥胖胃癌患者及殘胃癌患者中的應(yīng)用價(jià)值及微創(chuàng)優(yōu)勢(shì)。對(duì)比研究:1.腹腔鏡胃癌根治術(shù)與開腹手術(shù)患者的臨床療效;2.腹腔鏡手術(shù)方式和開腹手術(shù)方式在肥胖患者中行胃癌根治術(shù)的臨床療效。臨床療效分別從手術(shù)時(shí)間、淋巴結(jié)清掃情況、術(shù)中出血量、術(shù)后進(jìn)流食時(shí)間、術(shù)后進(jìn)固體食時(shí)間、排氣時(shí)間、引流管拔除時(shí)間、留置導(dǎo)尿管時(shí)間、術(shù)后使用鎮(zhèn)痛劑的例數(shù)、住院總費(fèi)用、手術(shù)切口長(zhǎng)度、術(shù)后并發(fā)癥及術(shù)后住院時(shí)間,術(shù)后1-3年生存率等進(jìn)行對(duì)比研究,以確定腹腔鏡手術(shù)在胃癌患者中的應(yīng)用價(jià)值。結(jié)果1.腹腔鏡組與開腹組在胃癌根治術(shù)中性別、年齡、BMI、標(biāo)本遠(yuǎn)近切緣長(zhǎng)度、清掃淋巴結(jié)的數(shù)目、術(shù)后病理分期和腫瘤直徑等均相似兩組比較無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)中出血量、術(shù)后進(jìn)流食時(shí)間、術(shù)后進(jìn)固體食時(shí)間、排氣時(shí)間、引流管拔除時(shí)間、留置導(dǎo)尿管時(shí)間、術(shù)后使用鎮(zhèn)痛劑的例數(shù)、切口長(zhǎng)度、術(shù)后住院天數(shù)、術(shù)后并發(fā)癥方面腹腔鏡組均優(yōu)于開腹組;差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后淋巴結(jié)清掃數(shù),兩組相比無(wú)顯著性差異(P0.05)。術(shù)后住院費(fèi)用腹腔鏡組高于開腹組兩組比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。2.針對(duì)腹腔鏡技術(shù)在肥胖病人胃癌手術(shù)中的應(yīng)用,腹腔鏡組與開腹組病人的性別、年齡、BMI、標(biāo)本遠(yuǎn)近切緣長(zhǎng)度、清掃淋巴結(jié)的數(shù)目、術(shù)后病理分期和腫瘤直徑等均相似,兩組病人基線一致統(tǒng)計(jì)學(xué)比較均無(wú)意義(P0.05)。術(shù)中出血量,排氣時(shí)間、切口長(zhǎng)度,術(shù)后使用鎮(zhèn)痛劑的例數(shù)、術(shù)后進(jìn)流食時(shí)間、術(shù)后鎮(zhèn)痛藥應(yīng)用次數(shù)及住院天數(shù)方面,腹腔鏡組優(yōu)于開腹組。腹腔鏡組的術(shù)后并發(fā)癥發(fā)生率與開腹組相比無(wú)明顯統(tǒng)計(jì)學(xué)意義,(P0.05),術(shù)后住院總費(fèi)用腹腔鏡組高于開腹組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組術(shù)后3年生存率比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。3.腹腔鏡技術(shù)在殘胃癌手術(shù)應(yīng)用中;手術(shù)時(shí)間160-310 min,平均(200±55)min;術(shù)中出血10-200 m1.平均(110±80)ml。清掃淋巴結(jié)數(shù)目為12-35枚平均(19±7.0)枚;術(shù)后肛門排氣時(shí)間2-5d,平均(3.1±1.0)d;術(shù)后進(jìn)半流食時(shí)間4-10d,平均(5.3±1.6)d;術(shù)后下床活動(dòng)時(shí)間1-3d,平均(1.6±0.8)d;術(shù)后住院天數(shù)7-15 d,平均(8.4±3)d;總住院費(fèi)用(萬(wàn)元)4.5-9.1萬(wàn)元,平均(5.9±1.3)萬(wàn)元;術(shù)后并發(fā)癥發(fā)生率為6.6%(2/30);中位隨訪18個(gè)月,隨訪率93.4%。隨訪期間,因肝臟轉(zhuǎn)移死亡2例;因腹膜轉(zhuǎn)移死亡6例,余20例病人一般情況良好。結(jié)論1.腹腔鏡胃癌根治術(shù)治療胃癌是安全可行的,腫瘤根治性與開腹手術(shù)相同,腹腔鏡胃癌根治術(shù)具有出血少、創(chuàng)傷小、術(shù)后恢復(fù)快、進(jìn)食早、住院天數(shù)短等優(yōu)點(diǎn);腹腔鏡胃癌根治術(shù)在手術(shù)技術(shù)上已日漸成熟,中期療效滿意,能夠達(dá)到和開腹手術(shù)相同的療效,具有一定的微創(chuàng)優(yōu)勢(shì)。2.腹腔鏡技術(shù)在應(yīng)用于肥胖胃癌病人中具有很好的應(yīng)用價(jià)值,微創(chuàng)優(yōu)勢(shì)明顯,肥胖并非腹腔鏡胃癌根治術(shù)的禁忌癥。3.腹腔鏡在殘胃癌手術(shù)應(yīng)用中安全可靠、效果滿意,值得臨床推廣使用。
[Abstract]:Objective to study the application and clinical effect of laparoscopy in gastric cancer surgery. Materials and methods were used to extract the clinical data of laparoscopic radical gastrectomy and radical gastrectomy for gastric cancer at the Department of general surgery, people's Hospital of Zhengzhou University from December 2012 to December 2015, and to summarize the safety of laparoscopic radical gastrectomy for gastric cancer. The application value and minimally invasive advantages of laparoscopy in the patients with gastric cancer and gastric stump. Comparative study on the clinical efficacy of 1. laparoscopic radical gastrectomy and laparotomy; 2. laparoscopic surgery and open surgery in obese patients with radical gastrectomy. The condition of dissection, intraoperative bleeding, postoperative intake of feeding time, postoperative solid food time, exhaust time, drainage time, catheter removal time, the number of postoperative analgesics, total hospitalization expenses, operative incision length, postoperative complications and postoperative hospital stay, and 1-3 year survival rate after operation were compared to determine abdomen. The value of endoscopic surgery in the patients with gastric cancer. Results 1. the sex, age, BMI, the length of the close margin of the specimen, the number of lymph nodes, the postoperative pathological stage and the diameter of the tumor were similar in two groups (P0.05). Solid food time, exhaust time, drainage tube extraction time, indwelling catheter time, postoperative use of analgesics, length of incision, postoperative hospitalization days, postoperative complications were better than laparoscopy group (P0.05). There was no significant difference between the two groups after operation (P0.05). The difference between the two groups of the laparoscopy group was higher than that of the open group (P0.05) the difference was statistically significant (.2.) for the application of the laparoscopy in the operation of the gastric cancer in the obese patients. The sex, age, BMI, the length of the specimen, the number of lymph nodes, the pathological staging and the diameter of the tumor were similar in the two groups. There was no significant difference in baseline Statistics (P0.05). The amount of bleeding, the time of exhaust, the length of the incision, the number of postoperative analgesics, the time of postoperative feeding, the number of postoperative analgesics and the days of hospitalization were better than those in the open group. The incidence of postoperative complications in the laparoscopic group was not statistically significant compared with that in the laparotomy group. P0.05, the total cost of postoperative hospitalization was higher than that in the laparotomy group. The difference was statistically significant (P0.05). There was no significant difference in the 3 year survival rate between the two groups (P0.05).3. laparoscopy in the application of the gastric stump operation; the operation time was 160-310 min, the average (200 + 55) min, and the mean (110 + 80) ml. cleaning lymph nodes in the intraoperative hemorrhage (110 + 80). The number of nodal numbers was 12-35 (19 + 7), and the postoperative anus exhaust time was 2-5d, average (3.1 + 1) d; the time to enter the half feeding time was 4-10d, the average (5.3 + 1.6) d after operation; the ambulation time after operation was 1-3D, average (1.6 + 0.8) d; the hospital days were 7-15 D, average (8.4 + 3) d; the total hospitalization cost (RMB) 4.5-9.1 yuan, average (5.9 +) million yuan; postoperative complications The incidence was 6.6% (2/30), the median follow-up was 18 months, 2 cases died of liver metastasis, 6 cases died of peritoneum metastasis and 20 cases were generally good. Conclusion 1. laparoscopic radical gastrectomy for gastric cancer is safe and feasible, the radical resection of the tumor is the same as that of the open operation, and the laparoscopic radical gastrectomy for gastric cancer is less bleeding. The advantages of small trauma, quick recovery, early feeding and short days of hospitalization, laparoscopic radical gastrectomy has become more and more mature in the surgical technique, and the medium-term effect is satisfactory, and it can achieve the same effect as that of the open operation. It has a certain minimally invasive advantage.2. laparoscopy in applying to fat fat gastric cancer patients with good application value and minimally invasive advantage. Obviously, obesity is not a contraindication for laparoscopic radical gastrectomy..3. laparoscopy is safe and reliable in the operation of gastric stump cancer. It is worthy of clinical application.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R735.2

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