全腔镜远端胃癌根治术与腹腔镜辅助远端胃癌根治术在术后消化道重建中的临床应用

Clinical study of totally laparoscopic versus laparoscopy-assisted distal gastrectomy in postoperative digestive tract reconstruction

摘要:

目的 比较全腔镜远端胃癌根治术与腹腔镜辅助远端胃癌根治术在消化道重建中的临床效果。方法 回顾性分析2022年1月—2025年1月邯郸市第一医院纺医院区收治的96例远端胃癌患者的病历资料。根据实际接受的手术方式，48例患者接受全腔镜远端胃癌根治术，纳入全腔镜组；48例接受腹腔镜辅助远端胃癌根治术，纳入腹腔镜组。比较两组患者的术中情况（手术时间、术中出血量、切口长度、淋巴结清扫总数），应激反应指标［前列腺素E2（PGE2）、促肾上腺皮质激素释放激素（CRH）、促肾上腺皮质激素（ACTH）］，采用生活质量综合评定问卷（GQOLI-74）评估患者生活质量，术后恢复情况（开始进食时间、首次排气时间、引流管拔除时间、住院时间），以及并发症的发生情况。结果 全腔镜组患者的手术时间短于腹腔镜组（P <0.05），术中出血量低于腹腔镜组（P <0.05），切口长度短于腹腔镜组（P <0.05）。两组患者的淋巴结清扫总数比较，差异无统计学意义（P >0.05）。腹腔镜组手术前后PGE2、CRH和ACTH的差值均大于全腔镜组。全腔镜组手术前后GQOLI-74评分差值大于腹腔镜组（P <0.05）。全腔镜组患者的开始进食时间、首次排气时间、引流管拔除时间和住院时间均低于腹腔镜组（P <0.05）。全腔镜组与腹腔镜组切口感染、切口出血、吻合口瘘和吻合口狭窄比较，差异均无统计学意义（P >0.05）。结论 全腔镜远端胃癌根治术较腹腔镜辅助远端胃癌根治术恢复效果良好，具有更轻的应激反应，不增加并发症风险，是安全有效的消化道重建方式。

Abstract:

Objective To compare the clinical outcomes of totally laparoscopic distal gastrectomy (TLDG) and laparoscopy-assisted distal gastrectomy (LADG) in digestive tract reconstruction.Methods A retrospective analysis was conducted on the medical records of 96 patients with distal gastric cancer who were admitted to the Textile Hospital District of Handan First Hospital between January 2022 and January 2025. According to the actual surgical procedure received, 48 patients underwent totally laparoscopic distal gastrectomy and were assigned to the totally laparoscopic group, while the remaining 48 patients underwent laparoscopy-assisted distal gastrectomy and were assigned to the laparoscopy-assisted group. Intraoperative parameters (operative time, intraoperative blood loss, incision length, total number of dissected lymph nodes), stress response markers [prostaglandin E2 (PGE2), corticotropin-releasing hormone (CRH), adrenocorticotropic hormone (ACTH) ], quality of life (assessed by the Generic Quality of Life Inventory-74, GQOLI-74), postoperative recovery (time to initiation of oral intake, time to first flatus, drainage tube removal time, hospital stay), and complication rates were compared between the two groups.Results Compared to the laparoscopy-assisted group, the totally laparoscopic group exhibited shorter operative time (P < 0.05), less intraoperative blood loss (P < 0.05), and smaller incision length (P < 0.05). The comparison of the total number of dissected lymph nodes between the two groups showed no statistically significant difference (P > 0.05). The differences in PGE2, CRH, and ACTH levels before and after surgery were greater in the laparoscopy - assisted group than in the totally laparoscopic group (P < 0.05). The difference in GQOLI-74 scores before and after surgery was greater in the totally laparoscopic group (P < 0.05). The totally laparoscopic group also showed earlier initiation of oral intake (P < 0.05), shorter time to first flatus (P < 0.05), earlier drainage tube removal, and reduced hospital stay (P < 0.05). No statistically significant differences were observed in the incidence of incision infection, incision bleeding, anastomotic leakage, or anastomotic stenosis between the two groups (P > 0.05).Conclusion TLDG is superior to LADG in promoting postoperative recovery, attenuating surgical stress response, and maintaining comparable safety, making it an effective and reliable approach for digestive tract reconstruction.