中国实用外科杂志

中国实用外科杂志

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腹腔镜辅助胃癌根治术不留置胃管临床研究

杨璐霄1，何    亮1，张加鑫1，李    梦2，王    权1   

  1. 1 吉林大学第一医院胃结直肠肛门外科，吉林长春 130021；2 吉林大学公共卫生学院，吉林长春 130021
  • 出版日期:2020-04-01 发布日期:2020-04-17

  • Online:2020-04-01 Published:2020-04-17

摘要： 目的    探讨腹腔镜辅助胃癌根治术不留置胃管的安全性与可行性。方法    回顾性分析2016年1月至2018年6月吉林大学第一医院胃结直肠肛门外科收治的行腹腔镜辅助胃癌根治术病人的临床资料，其中围手术期留置胃管503例和不留置胃管504例，采用倾向性评分匹配法（PSM方法）进行两组间1∶1匹配， 留置胃管组与不留置胃管组各入组356例。分析比较两组病人术后排气排便时间、术后住院时间及术后并发症发生情况。结果    留置胃管组发生咽喉疼痛71例（19.9%）、肺炎27例（7.6%）、胸腔积液28例（7.9%），术后平均住院时间为9 d，不留置胃管组咽喉疼痛17例（4.8%）、肺炎9例（2.5%）、胸腔积液11例（3.1%），术后平均住院时间为7 d，两组差异有统计学意义（P<0.05）。留置胃管组与不留置胃管组在术后吻合口漏［2例（0.6%）vs. 2例（0.6%），P>0.999］、术后出血［6例（1.7%）vs. 4例（1.1%），P=0.524］以及肠梗阻［2例（0.6%）vs. 6例（1.7%），P=0.155］的发生率方面差异无统计学意义。结论    腹腔镜辅助胃癌根治术不留置胃管能有效缩短术后住院时间，降低肺部并发症及咽喉疼痛的发生率，促进病人早期康复，与围手术期留置胃管相比更具优势。

关键词: 加速康复外科, 腹腔镜, 胃癌, 胃管

Abstract: Application of gastric-free tube in laparoscopic radical gastrectomy        YANG Lu-xiao*，HE Liang，ZHANG Jia-xin，et al. *Department of Gastrointestinal and Anal Surgery，Jilin University First Hospital，Changchun 130021，China
Corresponding author：WANG Quan，E-mail：wangqjdyy@163.com
Abstract    Objective    To study the safety and feasibility of laparoscopic assisted radical gastrectomy in patients without gastric tube after operation. Methods    The clinical data of patients undergoing laparoscopic-assisted radical gastrectomy in Department of Gastrointestinal and Anal Surgery，Jilin University First Hospital from January 2016 to June 2018 were analyzed retrospectively. Among them，there were 503 patients with indwelling gastric tube and 504 without indwelling gastric tube during the perioperative period. The propensity score matching method (PSM method) was used for 1∶1 matching between the two groups. After matching，the number of patients in the indwelling gastric tube group and the non-indwelling gastric tube group were 356 respectively. Analysis and comparison of postoperative exhaust and defecation time，postoperative hospital stay，and postoperative complications were performed  between the two groups of patients. Results    In the indwelling gastric tube group，71 patients (19.9%) experienced sore throat，27 patients (7.6%) had pneumonia，28 patients (7.9%) had pleural effusion，and the average postoperative hospital stay was 9 days. In the non-indwelling gastric tube group，17 patients (4.8%) experienced throat pain，9 patients (2.5%) had pneumonia，11 patients (3.1%) had pleural effusion，and the average postoperative hospital stay was 7 days . The differences were found to be statistically significant (P<0.05). Postoperative anastomotic fistula ［2 cases (0.6%) vs. 2 cases (0.6%)，P> 0.999］，postoperative bleeding ［6 cases (1.7%) vs. 4 cases (1.1%)，P=0.524］，and the incidence of intestinal obstruction ［2 cases (0.6%) vs. 6 cases (1.7%)，P=0.155］ was not statistically significant between the indwelling gastric tube group and the non-indwelling gastric tube group. Conclusion    Laparoscopic assisted gastric cancer radical surgery without indwelling gastric tube can effectively shorten postoperative hospitalization days，reduce the incidence of pulmonary complications and sore throat，promote early rehabilitation，and it has a better advantage than patients with indwelling gastric tube after laparoscopic assisted radical gastrectomy.

Key words: enhanced recovery after surgery, laparoscope, gastric cancer, gastric tube