上海交通大学学报（医学版）

上海交通大学学报（医学版）

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高龄患者腹腔镜下远端胃癌根治术的安全性分析

钱昌林1,3，刘骅1，3，张捷1，3，沈志勇1，3，张翀2，4，季福1，3   

  1. 上海交通大学 医学院 附属仁济医院南院 1.普外科， 2.老年科， 上海201112； 附属仁济医院 3.普外科， 4.老年科， 上海 200127
  • 出版日期:2015-12-28 发布日期:2016-01-21
  • 通讯作者: 张翀, 电子信箱: zhangchong@renji.com。
  • 作者简介:钱昌林(1984—)， 男， 住院医师， 硕士生; 电子信箱: lipids@126.com。
  • 基金资助:

    上海市卫生和计划生育委员会课题（201440523）

Analysis of safety of laparoscopy-assisted distal gastrectomy on elderly patients

QIAN Chang-lin1,3, LIU Hua1,3, ZHANG Jie1,3, SHEN Zhi-yong1,3, ZHANG Chong2,4, JI Fu1,3   

  1. 1.Department of Surgery, 2.Department of Geriatrics, Renji Hospital South Campus, Shanghai Jiao Tong University School of Medicine, Shanghai 201112, China； 3.Department of Surgery, 4.Department of Geriatrics, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
  • Online:2015-12-28 Published:2016-01-21
  • Supported by:

    Foundation of Shanghai Municipal Commission of Health and Family Planning, 201440523

PDF (PC)

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摘要：

目的  评价高龄患者（≥70岁）腹腔镜远端胃癌根治术的安全性。方法  采用前瞻性队列研究方法，选取100例择期高龄胃恶性肿瘤手术患者，随机分为腹腔镜组(n=50)和开腹组(n=50)。比较两组患者手术时间、术中出血量、术后首次排气时间、住院天数、并发症（吻合口漏、术后心肺相关并发症）、外周血白细胞计数及C反应蛋白的差异。 结果  腹腔镜组与开腹组手术时间无明显差异（P=0.086），两组术中出血量（P=0.016）、术后首次排气时间（P=0.000）、住院天数（P=0.000）的差异有统计学意义。吻合口漏腹腔镜组为2例，开腹组3例；术后心肺相关并发症腹腔镜组为6例，开腹组5例。术后1、3、7 d腹腔镜组的C反应蛋白、白细胞计数与开腹组均有明显差异（P=0.000）。结论  与开腹远端胃癌根治术相比，为高龄患者实施腹腔镜远端胃癌根治术安全可行，在术中出血、术后首次排气时间、住院时间、术后炎症因子指标方面较传统术式更有优势。

关键词: 腹腔镜, 胃癌, 安全性, 老年人

Abstract:

Objective  To evaluate the safety of laparoscopy-assisted distal gastrectomy on elderly patients (≥70 years old). Methods  The prospective cohort study was adopted. A total of 100 elderly patients with malignant gastric cancer were selected and randomly divided into laparoscopy group (n=50) and open surgery group (n=50). The operation time, intra-operative blood loss, post-operative flatus time, hospital stay, complications (anastomotic leakage and post-operative cardiopulmonary complications), peripheral blood leukocyte count, and C reactive protein of two groups were compared. Results  The difference of operation time of two groups was not significant (P=0.086), while the differences of intra-operative blood loss (P=0.016), post-operative flatus time (P=0.000), and hospital stay (P=0.000) of two groups were statistically significant. For laparoscopy group, there were 2 cases of anastomotic leakage and 6 cases of cardiopulmonary complications. For open surgery group, there were 3 cases of anastomotic leakage and 5 cases of cardiopulmonary complications. The differences of C reactive protein and leukocyte of two groups 1, 3, and 7 d after surgery were significant (P=0.000). Conclusion  Laparoscopy-assisted distal gastrectomy is more safe and feasible than open surgery for the treatment of elderly patients with distal gastric cancer in terms of intra-operative blood loss, postoperative flatus time, post-operative hospital stay, and post-operative inflammatory factors.

Key words: laparoscopy, gastric cancer, safety, the elderly