单孔+1孔对比传统多孔3D腹腔镜手术治疗进展期远端胃癌的近期疗效回顾性研究OACSTPCD

Objective To compare recent efficacy of single incision plus one laparoscopic surgery(SILS+1)with convention-al laparoscopic surgery(CLS)in patients with advanced distalgastric cancer.Methods From March 2021 to November 2022,data of 245 patients with advanced distalgastric cancer were retrospectively analyzed,and divided into CLS group(n=125)and SILS+1 group(n=120)according to surgical methods.And clinical data and indexes were compared and analyzed,including baseline data,operative time,intraoperative blood loss and blood transfusion,incidence of subcutaneous emphysema,open conversion,total number of lymph nodes dissection,negative marginrate,postoperative pain score(visual analogue scale,VAS),incision cosmetic score,postopera-tive parenteral and intestinal nutrition time,postoperative hospitalization time,perioperative complication rate,and total cost.Results There was no statistically significant difference in the baseline indicators of age,gender,body mass index(BMI),preoperative tumor stage,previous underlying medical history(hypertension,diabetes,COPD,coronary heart disease,history of abdominal surgery),tumor location and whether it was combined with pyloric obstruction(P>0.05).The incisional cosmetic scores SCAR in SILS+1 group were higher[(2.10±0.40)points vs.(3.29±0.51)points,P<0.05],intraoperative blood loss was less[(94.29±107.65)ml vs.(126.64±104.58)ml,P<0.05],and postoperative recovery of gastrointestinal function was quicker[(2.59±0.56)d vs.(2.90±0.50)d,P<0.05)].SILS+1 surgery took longer[(231.21±40.58)min vs.(203.66±54.78)min]and the time of tracheal intu-bation was longer[(273.00±48.16)min vs.(249.22±62.72)min],but their total number of intraoperative lymph nodes dissected was more thorough,with a higher number of dissected lymph nodes[(28.14±12.02)vs.(24.14±11.53)],all P>0.05.Patients who underwent SILS+1 had lower VAS scores than CLS on the first,second,and fourth postoperative day,and the difference was statistically significant(P<0.05).Tumor margins were negative in both groups,and there was no statistical significance in terms of intraoperative blood transfusion,status of open conversion,and incidence of subcutaneous emphysema(P>0.05).There was no difference between the two groups in terms of abdominal drainageat 3 days postoperatively,parenteral and intestinal nutrition time,length of hospitalization time,and hospitalization cost(P>0.05).In terms of postoperative complications,there were four cases of deep vein thrombosis events in SILS+1 group and five cases in CLS group,and one case of systemic inflammatory response syndrome was observed in both groups,with no statistically significant difference(P>0.05),whereas lung infection,abdominal infection,inci-sion infection,anastomotic fistula,postoperative hemorrhage,intestinal obstruction and other adverse events in SILS+1 group were lower than those in CLS group with statistically significant difference(P<0.05).Conclusion In terms of perioperative complications and early postoperative recovery indicators,the recent efficacy of SILS+1 group in the treatment of advanced distalgastric cancer is better than that of CLS,but the operation time of SILS+1 is slightly longer than that of CLS,and the value of SILS+1 in the treatment of advanced distal gastric cancer needs to be further investigated in a high-quality multicenter randomized controlled trial.