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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 ,
  • 刘骅 ,
  • 张捷 ,
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  • 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
钱昌林(1984—), 男, 住院医师, 硕士生; 电子信箱: lipids@126.com。

网络出版日期: 2016-01-21

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-lin ,
  • LIU Hua ,
  • ZHANG Jie ,
  • et al
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  • 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 published: 2016-01-21

Supported by

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

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。

本文引用格式

钱昌林 , 刘骅 , 张捷 , . 高龄患者腹腔镜下远端胃癌根治术的安全性分析[J]. 上海交通大学学报(医学版), 2015 , 35(12) : 1915 . DOI: 10.3969/j.issn.1674-8115.2015.12.029

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.

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