柔性牵拉策略在完全单孔腹腔镜远端胃癌根治术中的应用价值

Application value of flexible traction suspension strategy in pure single‑incision laparoscopic distal gastrectomy

    摘要
  • 摘要:
    目的 探讨柔性牵拉策略在完全单孔腹腔镜远端胃癌根治术（PSILDG）中的应用价值。
    方法 采用回顾性描述性研究方法。收集2021年11月至2024年3月陆军军医大学第二附属医院收治的12例行PSILDG患者的临床病理资料；男8例,女4例；年龄为（53±14）岁。观察指标：（1）术中情况。（2）术后情况。（3）随访情况。正态分布的计量资料以x±s表示,偏态分布的计量资料以M（Q1,Q3）表示。计数资料以绝对数表示。
    结果 （1）术中情况。12例患者均顺利采用柔性牵拉策略完成PSILDG,手术时间为（260±31）min,术中出血量为103.3（37.5,150.0）mL,手术切口长度为（3.9±0.6）cm；术中无特殊情况或并发症发生。（2）术后情况。术后组织病理学检查结果显示：12例患者中,腺癌10例、印戒细胞癌1例、高级别上皮内瘤变1例；肿瘤近端切缘距离为2.8（2.0,3.4）cm,远端切缘距离为5.9（5.0,7.5）cm,肿瘤长径为（2.3±1.0）cm,淋巴结清扫数目为（34±10）枚。12例患者术后第1 d视觉模拟评分均为1.0分,术后拔除胃管时间为1.25（1.00,1.75）d,术后首次进食流质食物时间为2.00（1.00,2.00）d,术后首次下床活动时间为1.67（1.00,2.00）d,术后首次肛门排气时间为2.40（2.00,3.00）d,术后首次肛门排便时间为3.50（2.00,5.00）d,术后住院时间为（7.10±1.40）d,术后腹壁切口满意度评分为（20.6±2.7）分。无患者发生术后并发症。（3）随访情况。12例患者均完成术后30 d随访,随访期间无并发症发生,无二次手术。
    结论 柔性牵拉策略应用于PSILDG安全、可行。

     

    Abstract:
    Objective To investigate the application value of flexible traction suspension (FTS) strategy in pure single‑incision laparoscopic distal gastrectomy (PSILDG).
    Methods The retrospective and descriptive study was conducted. The clinicopathological data of 12 patients who underwent PSILDG in The Second Affiliated Hospital of Army Medical University from November 2021 to March 2024 were collected. There were 8 males and 4 females, aged (53±14)years. Observation indicators: (1) intraoperative conditions; (2) postoperative conditions; (3) follow-up. Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were represented as M(Q1,Q3). Count data were described as absolute numbers.
    Results (1) Intraoperative conditions. All 12 patients underwent PSILDG with FTS strategy successfully, with the operation time of (260±31) minutes, the volume of intraoperative blood loss of 103.3(37.5,150.0)mL, the length of surgical incision of (3.9±0.6)cm. There was no intra-operative special circumstance or complication. (2) Postoperative conditions. Results of histopatho-logical examination showed that among the 12 patients, there were 10 cases of adenocarcinoma, 1 case of signet ring cell carcinoma, and 1 case of high‑grade intraepithelial neoplasia. The distance of the proximal tumor margin was 2.8(2.0,3.4)cm, the distance of distal margin was 5.9(5.0,7.5)cm, the tumor diameter was (2.3±1.0)cm, and the number of lymph node dissected was 34±10. On the post-operative first day, all 12 patients had a visual analog score of 1.0. The time to postoperative removal of gastric tube was 1.25(1.00,1.75)days, the time to postoperative first intake of liquid food was 2.00(1.00,2.00)days, the time to postoperative first out‑of‑bed activity was 1.67(1.00,2.00)days, the time to postoperative first flatus was 2.40(2.00,3.00)days, the time to postoperative first bowel movement was 3.50(2.00,5.00)days, the duration of postoperative hospital stay was (7.10±1.40) days, and the satisfaction score for the abdominal wall incision was 20.6±2.7. No patient experien-ced postopera-tive complications. (3) Follow‑up. All 12 patients completed a 30‑day follow‑up after surgery, with no complication or need for secondary surgery.
    Conclusion Application of FTS strategy in PSILDG is safe and feasible.

     

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