初学者腹腔镜胃癌D2根治手术安全性影响因素的临床分析

摘要

目的 探讨影响初学者手术安全性的临床因素,为初学腹腔镜胃癌根治术者提供技术参考.方法 回顾性分析我院胃肠外科自2008年6月—2012年5月初学者开展的腹腔镜辅助胃癌D2根治术79例患者的临床资料,以腹腔镜手术团队除术者外的其他成员独立开展第1例腹腔镜辅助胃癌根治术为时间截点,分为术者组(35例)和成员组(44例),比较手术效果、术中误损伤和术后并发症等临床评价指标,分析影响初学者手术安全性的临床因素.结果 两组均无手术死亡.手术中出血量、检获淋巴结数目和手术后住院时间,两组相当(P>0.05);手术切口长度和手术时间,其差异有显著统计学意义(P<0.05).手术残端癌残留,术者组0例;成员组1例.术中意外损伤,术者组胆囊管损伤1例;成员组3例,其中横结肠损伤2例.围手术期并发症率,术者组为22.86%(8/35),其中胃肠功能紊乱6例(17.14%);成员组为9.09%(4/44),胃肠功能紊乱3例(6.82%).结论 对于初学腹腔镜胃癌手术者,手术者经验和适当的手术切口长度可能是减少手术并发症的重要因素;采用预先保留大网膜的横结肠上入路淋巴结清扫路径能够有效的减少术中意外损伤.%Objective To explore the safety influencing factors for beginners in performing laparoscopy-assisted D2 radical gastrec-tomy for gastric cancer.Methods 79 cases received laparoscopy-assisted D2 radical gastrectomy for gastric cancer in Department of Gastrointestinal Surgery,Chengdu Military General Hospital in the period from June,2008 to May 2012,out of which,35 cases were performed by doctors who made the operations for the first time independently (group 1) while the left 44 cases were performed by doc-tors who had made the operations before (group 2);a retrospective analysis was made to the clinical data of the 79 cases and a compara-tive study was made to the operation effect,the occurrence of incidental injuries in operation and postoperative complications between the 2 groups;the safety influencing factors in the operations by the beginners were analyzed.Results No death occurred in both groups;there existed no difference in bleeding volume in operation,the number of lymph nodes excision and the time length of hospitalization after operation between the 2 groups (P>0.05) while there was a difference of obvious statistical significance in the length of incision and operation duration between the 2 groups (P<0.05);the residual cancer of operation stump was found in no case in group 1 but 1 case in group 2;1 case in group 1 had incidental injury in operation (cystic duct injury) while 3 cases in group 2,including 2 cases of trans-verse colon injury;the occurrence of complications in the perioperative period in group 1 was 22.86%(8/35),including 6 cases of gas-trointestinal dysfunction (17.14%),and 9.09%(4/44),including 3 cases of gastrointestinal dysfunction (6.82%).Conclusions For begin-ners of laparoscopy-assisted D2 radical gastrectomy for gastric cancer,certain experience accumulation and proper length of incision are the main factors in decreasing the occurrence of complications;taking transverse colon on the greater omentum preserved beforehand as the approach of lymph node excision can effectively reduce the occurrence of incidental injury in operation.