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目的比较腹腔镜与开腹胃癌根治术后早期并发症状性胸腔积液的差异性。方法回顾性分析2014年1月至2016年10月在华中科技大学同济医学院附属协和医院胃肠外科实施胃癌根治术的678例病人的临床资料。结果 678例胃癌根治术中66例术后出现了症状性胸腔积液,发生率为9.7%。腹腔镜组327例,术后胸腔积液为11例,发生率为3.4%;开腹组351例,术后胸腔积液为55例,发生率为15.7%,差异有统计学意义(χ2=29.17,P<0.05)。腹腔镜组中远端胃、近端胃、全胃、联合脏器切除分别为189例、38例、69例、31例,术后胸腔积液的例数分别为2例、3例、4例、2例,发生率分别为1.1%、7.9%、5.8%、6.5%。近端胃、全胃与联合脏器切除术后并发胸腔积液发生率之间比较,差异无统计学意义(P>0.05)。但三者与远端胃术后并发胸腔积液发生率之间比较,差异有统计学意义(P<0.05)。开腹组中远端胃、近端胃、全胃、联合脏器切除分别为122例、78例、114例、37例,术后胸腔积液的例数分别为8例、18例、19例、10例,发生率分别为6.6%、23.1%、16.7%、27.0%。近端胃、全胃与联合脏器切除术后并发胸腔积液发生率之间比较,差异无统计学意义(P>0.05)。但三者与远端胃术后并发胸腔积液发生率之间比较,差异有统计学意义(P<0.05)。分别对腹腔镜组与开腹组间远端胃、近端胃、全胃和联合脏器切除术后胸腔积液的发生率进行比较,差异均有统计学意义(P<0.05)。结论腹腔镜手术可能会减少胃癌根治术后早期症状性胸腔积液的产生。
Objective To compare the differences of early concurrent symptomatic pleural effusion after laparoscopy and open radical gastrectomy. Methods The clinical data of 678 patients who underwent radical gastrectomy from January 2014 to October 2016 in Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology were retrospectively analyzed. Results Sixty-six cases of radical resection of gastric cancer developed symptomatic pleural effusion, with a rate of 9.7%. There were 327 cases of laparoscopic group, 11 cases of postoperative pleural effusion, the incidence was 3.4%; 351 cases of open group, postoperative pleural effusion was 55 cases, the incidence was 15.7%, the difference was statistically significant (χ2 = 29.17, P <0.05). There were 189 cases, 38 cases, 69 cases and 31 cases of distal stomach, proximal stomach, total stomach and visceral resection in laparoscopic group. There were 2 cases of pleural effusion in 2 cases, 3 cases of 4 cases Cases, 2 cases, the incidence rates were 1.1%, 7.9%, 5.8%, 6.5%. There was no significant difference in the incidence of pleural effusion between proximal stomach, total stomach and combined organ resection (P> 0.05). However, there was a significant difference between the three and the incidence of pleural effusion after distal gastrocnemius (P <0.05). There were 122 cases, 78 cases, 114 cases and 37 cases respectively. The number of pleural effusion in open group were 8 cases, 18 cases and 19 cases Cases, 10 cases, the incidence was 6.6%, 23.1%, 16.7%, 27.0%. There was no significant difference in the incidence of pleural effusion between proximal stomach, total stomach and combined organ resection (P> 0.05). However, there was a significant difference between the three and the incidence of pleural effusion after distal gastrocnemius (P <0.05). The incidences of pleural effusion in the distal stomach, proximal stomach, total stomach and combined organ resection between the laparoscopic group and the open group were respectively compared, the difference was statistically significant (P <0.05). Conclusion Laparoscopic surgery may reduce the incidence of early symptomatic pleural effusion after radical operation of gastric cancer.