以层面为导向“六步六窗口法”在腹腔镜根治性全胃切除术中的应用价值

Application value of the anatomically oriented "six steps with six windows" approach in laparoscopic radical total gastrectomy

    摘要
  • 摘要:
    目的 探讨以层面为导向“六步六窗口法”在腹腔镜根治性全胃切除术中的应用价值。
    方法 采用回顾性队列研究方法。收集2019年1月至2022年2月河南省人民医院收治的121例行腹腔镜根治性全胃切除术患者的临床病理资料；男53例,女68例；年龄为（68±12）岁。121例患者中,72例行常规手术入路设为对照组,49例行“六步六窗口法”手术入路设为试验组。观察指标：（1）手术情况。（2）术后情况。正态分布的计量资料以x±s表示,组间比较采用t检验。计数资料以绝对数或百分比表示,组间比较采用χ²检验。
    结果 （1）手术情况。121例患者均完成腹腔镜根治性全胃切除术,无中转开腹。对照组和试验组患者手术时间、术中出血量、清扫淋巴结数目分别为（250±50）min、（150±34）mL、（41±6）枚和（180±16）min、（55±13）mL、（51±5）枚,两者上述指标比较,差异均有统计学意义（t=11.04,21.47,9.42,P<0.05）。（2）术后情况。对照组和试验组患者术后使用镇痛药次数,术后首次肛门排气时间,术后住院时间,术后病理学分期（Ⅰ期、Ⅱ期、Ⅲ期）,术后并发症发生率分别为（3.4±1.6）次,（4.0±1.4）d,（13.1±2.0）d,9、32、31例,15.3%（11/72）和（3.5±1.7）次,（4.1±1.5）d,（13.1±1.7）d,6、25、18例,16.3%（8/49）,两者上述指标比较,差异均无统计学意义（t=0.35、0.18、0.03,Z=0.55,χ²=0.02,P>0.05）。两组患者均无围手术期死亡。
    结论 以层面为导向“六步六窗口法”应用于腹腔镜根治性全胃切除术安全、可行。

     

    Abstract:
    Objective To investigate the application value of the anatomically oriented "six steps with six windows" approach in laparoscopic radical total gastrectomy.
    Methods The retros-pective cohort study was conducted. The clinicopathological data of 121 patients who underwent laparoscopic radical total gastrectomy in Henan Provincial People′s Hospital from January 2019 to February 2022 were collected. There were 53 males and 68 females, aged (68±12)years. Of the 121 patients, 72 patients using the traditional approach in the surgery were divided into the control group, and 49 patients using the "six steps with six windows" approach in the surgery were divided into the experiment group. Observation indicators: (1) surgical situations; (2) postoperative situations. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was conducted using the t test. Count data were described as absolute numbers or percen-tages, and comparison between groups was conducted using the chi‑square test.
    Results (1) Surgical situations. All 121 patients underwent laparoscopic radical total gastrectomy successfully, without laparotomy conversion. The operation time, volume of intraoperative blood loss, number of lymph nodes dissected were (250±50)minutes, (150±34)mL, 41±6 in the control group, versus (180±16)minutes, (55±13)mL, 51±5 in the experiment group, showing significant differences in the above indicators between the two groups (t=11.04, 21.47, 9.42, P<0.05). (2) Postoperative situations. The times of postoperative analgesic injection, time to postoperative first flatus, duration of postoperative hospital stay, postoperative pathological staging (stage Ⅰ, stage Ⅱ, stage Ⅲ), incidence of postoperative complication were 3.4±1.6, (4.0±1.4)days, (13.1±2.0)days, 9, 32, 31, 15.3%(11/72) in the control group, versus 3.5±1.7, (4.1±1.5)days, (13.1±1.7)days, 6, 25, 18, 16.3%(8/49), showing no significant difference in the above indicators between the two groups (t=0.35, 0.18, 0.03, Z=0.55,χ²=0.02, P>0.05). There was no perioperative death in both groups of patients.
    Conclusion Appli-cation of the anatomically oriented "six steps with six windows" approach in laparoscopic radical total gastrectomy is safe and feasible.

     

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