摘要
目的胃癌D2手术是目前公认标准的胃癌手术方式,腹腔镜在胃癌手术中的技术应用也得到了认可,文中探讨腹腔镜胃癌D2手术的学习曲线。方法回顾性分析100例腹腔镜胃癌患者D2手术的临床资料。按照手术日期先后分为5组(A、B、C、D、E),每组20例。比较各组的手术时间、出血量、淋巴结清扫个数、中转开腹率、并发症、肠功能恢复时间、术后住院时间及手术频度等。结果 5组病例在年龄、性别、肿瘤部位、病理分期和手术方式等方面差异无统计学意义(P>0.05)。A、B组手术时间分别为(312±52)m in、(306±54)m in,显著长于C组(271±31)m in、D组(265±35)m in和E组(257±33)m in(P<0.05);A、B组的术中出血量分别为(279±91)m l、(211±89)m l,明显多于C组(158±52)m l、D组(104±54)m l和E组(89±41)m l(P<0.05);手术频度由A组2.9例/月、B组4例/月逐渐上升到C组5例/月、D组6.7例/月、E组10例/月;中转开腹率由A组25%、B组20%下降到C组10%、D组5%、E组5%;5组淋巴结清扫数量、并发症发生率及肠道通气时间、术后住院天数等临床指标差异无统计学意义。结论腹腔镜胃癌D2手术的学习曲线大致为40例。
Objective Gastrectomy with D2 lymphadenectomy is accepted as standard surgery for gastric cancer,and the application of laparoscopy was approved to be effective in gastric cancer operation.This study investigated the learning curve of laparoscopic gastrectomy with D2 lymphadenectomy for gastric cancer.Methods We retrospectively analyzed the clinical data of 100 cases of laparoscopic gastrectomy with D2 lymphadenectomy.In order of the dates of surgery,the patients were equally divided into groups A,B,C,D and E.Comparisons were made among the five groups in operation time,blood loss,number of lymph nodes resected,rate of conversion to open surgery,postoperative complications,postoperative hospital stay,and frequency of surgery.Results No significant differences were found in age,sex,TNM stage,and surgical procedures among the five groups.The operation time was significantly longer in groups A and B than in C,D and E（[262±52] and [256±54] min vs [221±31],[215±35] and [207±33] min,P0.05）,and blood loss in surgery was significantly more in the former two than in the latter three（[279±91] and [211±89] ml vs [158±52],[104±54] and ml;P0.05）.The frequency of surgery was increased from 2.9 cases a month in group A to 4,5,6-7 and 10 cases a month in B,C,D and E,while the rate of conversion to open surgery decreased from 25% in group A to 20%,10%,5% and 5% in B,C,D and E.No significant differences were observed in the number of lymph nodes resected,rate of postoperative complications,intestinal recovery ventilation time,and postoperative hospital stay among the five groups.Conclusion The learning curve of laparoscopic gastrectomy with D2 lymphadenectomy for gastric cancer is about 40 cases.
出处
《医学研究生学报》
CAS
2011年第9期923-926,共4页
Journal of Medical Postgraduates
基金
江苏省社会发展基金(BS2007054)
南京军区科技创新基金(07Z028)
关键词
加速康复外科
腹腔镜
胃癌
学习曲线
Fast-track surgery
Laparoscopy
Gastric cancer
Learning curve
