腹腔镜技术在胃癌治疗中已得到广泛应用,大量前瞻性研究也证实了其手术安全性.腹腔镜下操作空间多依靠CO2气腹构建,对高龄或心肺基础较差的患者可能增加围手术期并发症的发生风险,因此,自20世纪90年代起以悬吊技术为代表的免气腹技术可在一定程度上替代传统气腹,扩大了腹腔镜胃癌手术的适应证.目前大量免气腹装置的研发推动了此技术在胃癌手术中的普及应用.基于此,我们制定此操作规范,旨在通过介绍新型免气腹悬吊技术的操作要点,规范免气腹腔镜胃癌根治术的手术操作流程,以期为临床进一步推广应用提供参考.

目的:探讨新辅助化疗后机器人胃癌根治术后近期并发症的相关危险因素,以期为有效预防术后并发症拓展思路.方法:回顾收集2012年11月至2020年10月行新辅助化疗后机器人胃癌根治术的89例胃癌患者的临床资料与病理资料.并发症分级按照Clavien-Dindo系统进行评价.采用二元logistic回归分析影响新辅助化疗后机器人胃癌根治术术后并发症的危险因素,将单因素分析中P<0.2的影响因素纳入多因素logistic回归分析.总体生存及无进展生存采用Kaplan-Meier法分析并绘制生存曲线,组间比较采用log-rank检验.结果:89例患者被纳入该项研究,26例(29.2％)于术后30 d内出现Clavien-Dindo分级≥Ⅱ级的术后并发症;8例(9.0％)出现严重并发症(Clavien-Dindo分级≥Ⅲa级),分别为3例吻合口漏、1例腹腔出血、3例呼吸功能障碍、1例因肺炎围手术期死亡.多因素分析结果显示,手术时间>280 min(OR=3.409,95％CI:1.144-10.163,P=0.028)与存在腹部手术史(OR=4.888,95％CI:1.265-18.888,P=0.021)是影响患者术后并发症发生的独立危险因素.术后有并发症与无并发症患者的3年总体生存率分别为52.4％与59.4％,差异无统计学意义(P=0.355);3年无病生存率分别为38.6％与57.4％,差异亦无统计学意义(P=0.400).结论:新辅助化疗后机器人胃癌根治术操作安全、可行,对于有腹部手术史、手术时间>280 min的患者,新辅助化疗后应谨慎选择机器人胃癌根治术.

背景 高龄是胃癌术后近期并发症的独立危险因素.近年来,微创胃癌手术已成为高龄胃癌患者的手术方式,但目前对于高龄患者微创胃癌根治术术后并发症影响因素的研究相对较少.目的 分析高龄胃癌患者微创胃癌根治术术后近期并发症及影响因素.方法 采用回顾性研究,收集2017年4月-2021年4月492例于解放军总医院第一医学中心普通外科医学部行微创胃癌根治术且年龄≥70岁患者(包括2D腹腔镜、3D腹腔镜及机器人手术)的临床病历资料,通过单因素及多因素分析探究影响术后30 d并发症的独立危险因素.结果 492例中103例(20.9％)出现Clavien-Dindo分级≥Ⅱ级的术后并发症;24例出现Clavien-Dindo分级≥Ⅲa级的并发症,严重并发症发生率为4.9％;2例围术期死亡(1例腹腔出血,1例肺栓塞),围术期死亡率0.4％.单因素分析结果显示,脉管侵犯、年龄≥80岁、术中出血量≥200 mL与高龄胃癌患者微创胃癌根治术术后30 d内并发症相关(P均<0.05),微创手术方式(腹腔镜、3D腹腔镜或机器人)与术后并发症无明显相关性(P=0.096).多因素logistic分析结果显示,脉管侵犯(OR=1.985;95％CI:1.267～3.110;P=0.003)、术中出血量≥200 mL(OR=2.120;95％CI:1.193～3.769,P=0.010)与高龄胃癌患者微创胃癌根治术术后30 d内并发症独立相关.结论 高龄胃癌患者行微创胃癌根治术安全可行,近期疗效确切.脉管侵犯、术中出血量≥200 mL与高龄胃癌患者微创胃癌根治术术后30 d内并发症独立关联,应对此类患者加以重视,术前充分评估以降低并发症发生率.

腹膜后脂肪肉瘤（RLS）的病理亚型是决定患者预后的重要指标，全面认识该肿瘤的常见病理亚型对改善患者预后及临床治疗结局具有重要作用。RLS的几种常见病理亚型各具特色又相互联系，甚至可以相互转化。高分化和低分化脂肪肉瘤是最为常见的病理亚型，具有相似的起源和基因改变，但两者的临床特征有时又极为不同，两者是RLS中最具代表性的两类病理亚型。黏液性和多形性脂肪肉瘤是次常见的两种类型，前者为中等恶性，后者为高度恶性。近年来，随着认识的不断深入，又新增了一些病理亚型。本文就目前已知亚型的RLS最新进展进行综述，讨论各种亚型的临床病理特征，以期对该病的诊疗提供一定参考。

背景 胃癌是一种十分常见的肿瘤,由于缺乏早期诊断的分子标志,多数胃癌发现时已是中晚期.因此,亟需探索更加有效的预测和治疗靶点以改善胃癌患者的病情.目的 探讨敲低长链非编码RNA CCAT2(long non-coding RNA CCAT2,lncRNA CCAT2)对胃癌细胞糖酵解水平以及细胞增殖能力的影响.方法 采用siRNA敲低胃癌细胞系BGC-823、HGC-27内lncRNA CCAT2的表达水平,酶标比色法检测乳酸、ATP、丙酮酸含量以及葡萄糖摄取速度,Western blot检测糖酵解相关蛋白的表达水平.CCK-8和EdU(5-ethynyl-2-deoxyuridine)实验检测胃癌细胞的增殖能力.结果 靶向lncRNA CCAT2的siRNA成功转染进入BGC-823、HGC-27胃癌细胞系并敲低lncRNA CCAT2表达水平,ATP、乳酸、丙酮酸含量以及葡萄糖摄取速度均明显下降(P<0.05).Western blot检测结果显示,葡萄糖转运蛋白1、己糖激酶2、磷酸甘油酸变位酶1、乳酸脱氢酶ɑ的表达水平均明显下调(P<0.05).CCK-8和EdU实验结果显示,敲低lncRNA CCAT2后胃癌细胞的增殖能力受到明显抑制(P<0.05).结论 lncRNA CCAT2是胃癌细胞糖代谢重编程的调节靶点,敲低CCAT2可以抑制其糖酵解水平和细胞增殖能力.

目的:探讨加速康复外科(ERAS)在3D腹腔镜辅助胃癌根治术中的安全性与可行性.方法:收集2018年1月至6月在ERAS路径下行3D腹腔镜辅助胃癌根治术患者的临床资料.计算患者ERAS路径的依从性.采用单因素与多因素分析患者延迟出院的影响因素.结果:共纳入84例行3D腹腔镜辅助胃癌根治术的患者.8例(9.5％)术后发生Clavien-DindoⅡ级以上并发症,术后无一例死亡.ERAS路径的依从性为0.69(IQR:0.50～0.88).单因素回归分析结果显示,手术时间、出血量及ERAS路径的依从性为患者延迟出院的影响因素(P<0.05),但多因素回归分析结果表明,仅ERAS路径为患者延迟出院的独立影响因子(P=0.001).ERAS路径依从性与术后住院时间显著负相关(Spearman r=-0.7,P<0.001).高ERAS依从性患者住院费用更低(P=0.031).结论:采用ERAS路径行3D腹腔镜胃癌根治术是安全、可行的.高ERAS依从性可促进患者康复,缩短住院时间,减少住院费用.

目的 探讨胃神经内分泌肿瘤(gastric neuroendocrine neoplasm,gNEN)患者术前血清白蛋白水平的临床意义及其评估预后的价值.方法 收集2001年6月-2017年12月于解放军总医院第一医学中心行手术治疗的134例胃神经内分泌肿瘤患者的临床和病理资料.依照术前血清白蛋白指标分为血清白蛋白正常组(≥35 g/L)和降低组(＜35 g/L).探究两组的临床病理特征差异,使用Kaplan-Meier法建立生存分析模型,以log-rank检验和Cox比例风险模型进行生存分析,探索影响gNEN患者术后生存的因素.结果 血清白蛋白降低组31例,正常组103例,术前血清白蛋白水平降低与患者年龄大和肿瘤直径大有关.生存分析显示术前血清白蛋白正常组和降低组的2年生存率分别为66.89％和和43.29％,差异有统计学意义(P=0.000).单因素分析结果显示,淋巴结转移、远处转移、肿瘤TNM分期、手术方式和术前血清白蛋白水平影响胃神经内分泌肿瘤患者术后的总生存率.多因素Cox风险比例模型显示,淋巴结转移(HR:2.340;95％ CI:1.260～ 4.346)、远处转移(HR:2.042;95％ CI:1.024～ 4.072)为gNEN预后不良的独立预测因素,采用微创手术(HR:0.361;95％ CI:0.139 ～0.676)及术前血清白蛋白水平≥35 g/L(HR:0.366;95％ CI:0.208～0.643)是预后良好的独立预测因素.结论 术前血清白蛋白水平可作为胃神经内分泌肿瘤患者预后的独立预测因素,可能成为gNEN预后的预测指标.

Objective: To investigate and compare the abilities of robot-assisted gastrectomy (RAG) and laparoscopy-assisted gastrecto-my (LAG) to remove lymph nodes in technically demanding areas. Methods: Between August 2014 and August 2015, 61 patients who underwent RAG and 235 patients who underwent LAG were enrolled in this study. Clinical characteristics, operative parameters, and pathological and oncological data were collected prospectively, and the numbers of retrieved lymph nodes for each station were ana-lyzed in accordance with the extent of surgery. Results: More lymph nodes were retrieved in the RAG group than in the LAG group (P=0.046). Similarly, the RAG group had more retrieved lymph nodes in the N2 area (P=0.038). In patients who underwent distal gastrecto- my, the numbers of retrieved lymph nodes around the splenic artery area using RAG and LAG were 2.8±1.7 and 2.2±1.2, respectively (P=0.036). In patients who underwent total gastrectomy, 2.8±1.2 and 2.1±1.0 lymph nodes were retrieved with RAG and LAG around the splenic artery area, respectively (P=0.049). The mean numbers of lymph nodes retrieved around the splenic hilum were 1.8±0.8 and 1.3±0.7, respectively (P=0.042). The intraoperative blood transfusion rate (P=0.617), postoperative hospital days (P=0.071), proxi-mal resection margin (P=0.064), and distal resection margin (P=0.667) were not significantly different between the two groups. The numbers of postoperative complications were also similar between the RAG and LAG groups (P=0.854). However, RAG had less severe complications according to the Clavien-Dindo classification (P=0.039). Conclusions: This study demonstrated that RAG had advantages over LAG regarding lymph node dissection in technically demanding areas and might contribute to radical D2 lymphadenectomy with less severe complications.

Objective: To explore the clinicopathological characteristics and prognostic factors of patients with ovarian metastasis from gastric cancer. Methods: We retrospectively analyzed the clinical data and treatment strategies of 83 patients with metastatic ovarian tumors treated at PLA General Hospital between January 2006 and December 2017. Univariate analysis using the Log-rank test and multivariate analysis using the Cox proportional-hazards model were used to identify the prognostic factors. Results: The median diam-eter of the metastatic ovarian tumors was 7.1 (1.0-24.0) cm. Of these patients, 36 (43.4%) had unilateral metastasis and 47 (56.6%) had bilateral metastasis; 35 (42.2%) patients had peritoneal metastasis. All patients received chemotherapy, including 57 (68.7%) pa-tients who underwent combined-modality resection of the metastatic tumors and 22 patients (26.5%) who received hyperthermic in-traperitoneal chemotherapy. Of these patients, 74 (89.1%) were followed up, with a median survival time of 15 [95% confidence inter-val (CI): 12.5-17.5] months. The 1-year, 3-year, and 5-year overall survival rates were 71.1%, 6.5%, and 0, respectively. Univariate analy-sis showed that risk factors including≥6 metastatic lymph nodes, metastasectomy, synchronous ovarian metastasis, peritoneal carcino-matosis, estrogen receptor (ER) positivity, and high levels of serum carcinoembryonic antigen and cancer antigen-125 (CA125) might af-fect the prognosis (P<0.05). Multivariate analysis showed that metastasectomy, synchronous ovarian metastasis, combined peritoneal carcinomatosis, and ER positivity were independent factors affecting prognosis (P<0.05). Conclusions: We found that the presence of synchronous ovarian metastasis or combined peritoneal carcinomatosis indicated a poor prognosis; in contrast, ER-positivity predicted a better prognosis than ER-negativity. Metastasectomy may prolong the survival of patients.

OBJECTIVE:To investigate the risk factors of prolonged postoperative ileus (PPOI) after gastric cancer surgery.METHODS:Definition of PPOI was that gastrointestinal function did not return to normal within 96 hours after operation. Diagnostic criteria of PPOI were as follows: according with over 2 below conditions at postoperative 97-hour: (1) moderate to severe sick (mild: 1-3 points, moderate: 4-7 points, severe: 8-10 points) or vomiting occurred in past 12 hours. (2) patient was intolerable of solid food in the last 2 meals and reported the food-intake as less than 25%. (3) no flatus and defecation occurred in past 24 hours. (4) moderate to severe abdominal distension was diagnosed by doctor with knocking abdomen. (5) iconography examination (abdominal X-ray or CT) in past 24 hours revealed gastrectasis, gas-fluid plane, intestinal or colorectal loop extension, indicating the ileus. A total of 83 patients with gastric carcinoma confirmed by preoperative gastroscopic pathology undergoing operation at the Department of General Surgery, Chinese PLA General Hospital from August 2016 to October 2016 were prospectively enrolled in the study. The incidence and risk factors of PPOI after gastric cancer surgery were calculated and analyzed with univariate and logistic regression multivariate analyses.RESULTS:Of 83 gastric cancer patients, 62 were male and 21 were female with an average age of (60.1±11.0)(39-89) years. Postoperative pathology showed 41 cases with III(-IIII( stage, 42 cases with I(-II( stage. According to the above diaguostic criteria, 22(26.5%) patients were diagnosed as PPOI postoperatively. Among 22 cases, 3 cases had no flatus and defecation with moderate-severe sick and vomiting within postoperative 96 hours; 15 cases had no flatus and defecation with moderate-severe abdominal extension within postoperative 96 hours; 4 cases had no flatus and defecation with moderate-severe sick, vomiting and moderate-severe abdominal extension within postoperative 96 hours. Clinical symptoms of all the POOI patients were improved following conservative treatment. Univariate analysis showed that age ≥65 years[13/26(50.0%) vs. 9/57(15.8%), χ2=10.727, P=0.001], postoperative body temperature ≥38.0centi-degree [8/17(47.1%) vs. 14/66(21.2%), χ2=4.636, P=0.031], postoperative serum potassium level[20/81(24.7%) vs. 2/2, χ2=5.682, P=0.017], and use of opioid agent Dezocine [15/38(39.5%) vs. 7/45(15.6%), χ2=6.050, P=0.014] were associated with POOI. Logistic regression analysis showed that age ≥65 years (OR=17.415, 95%CI:17.151-17.750, P=0.015), postoperative body temperature ≥38centi-degree(OR=15.855, 95%CI:15.422-16.214, P=0.013), use of Dezocine after surgery (OR=21.379, 95%CI:20.814-21.654, P=0.010) were the independent risk factors of PPOI after gastric cancer surgery.CONCLUSION:Gastric patients with older age, increased body temperature and the use of Dezocine after surgery have higher risk of POOI and need special perioperative management and treatment.

Objective To analyze the spectrum and drug resistance of the pathogens in patients with postoperative infection of general surgery, and provide the basis for the rational use of antibiotics. Methods The pathogen identification and drug susceptibility test were carried out in our hospital from January 2013 to January 2016, and the source, spectrum and drug resistance of pathogens were analyzed statistically. Results A total of 589 strains were isolated from 554 patients. They were mainly from tissues (41.52％), respiratory specimens [including sputum (24.55％), blood (9.75％), catheters (5.06％), peritoneal drainage and puncture fluid (4.33％), urine (4.15％), and pus (3.79％)]. Gram negative bacteria accounted for 74.19％ of the isolated pathogens, with gram positive bacteria of 20.03％ and fungi of 5.77％. Among them, Klebsiella pneumoniae and Escherichia coli were highly sensitive to imipenem and meropenem (sensibility ＞ 95％). Pseudomonas aeruginosa was sensitive to carbapenem antibiotics (sensibility ＞ 85％). However, acinetobacter baumannii presented drug resistance to a variety of antibiotics (drug resistance rate ＞ 50％). Enterococcus faecalis and Enterococcus faecium were highly sensitive to vancomycin (drug resistance rate of 0％). Conclusion The surgical infection is predominantly caused by gram negative bacteria which can be treated with carbapenem antibiotics, such as meropenem.

Objective: To identify the effects and potential mechanisms of hedyotis diffusa extracts on the occurrence and development of breast cancer in tumor-bearing mice, and thus provide experimental evidences for the following clinical application of hedyotis diffusa. Methods: Twelve-week-old male BALB/c mice (n=30) were randomly and equally assigned into 3 groups, including the blank control (Control), breast cancer (BC) and breast cancer with hedyotis diffusa treatment (BC+HD) groups. The mice in the BC and BC+HD groups were subjected to injection of MCF-7 cell suspension (0.2 m L, 2×107/m L) from the right scapula. The mice in the Control group were injected with saline with the same volume. After two weeks, the mice in the BC+HD groups received hedyotis diffusa administration by gavage, the mice in the BC and Control groups received saline with the same volume. Twenty one days post hedyotis diffusa administration, all mice in the three groups were sacrificed, and the body weight, total feed volume, tumor weight and tumor volume were analyzed and quantified. The serum interleukelin-6 (IL-6) and vascular endothelial growth factor (VEGF) concentrations were also determined using the enzyme linked immunosorbent assay (ELISA) method. Results: At 21 days after treatment, the body weight of mice in the BC+HD group were significantly higher than those in the BC group (P＜0.05), and the total feed volume, tumor weight, tumor volume, serum IL-6 and serum VEGF concentrations in the BC+HD group were significantly lower than those in the BC group (P＜0.05).Conclusion: Hedyotis diffusa could significantly improve the nutritional status and inhibit the occurrence and development of breast cancer. This efficacy of hedyotis diffusa might be associated with the significant reduction of inflammation-related cytokine expression.

目的 报道1例双侧卵巢特殊影像形态库肯勃格瘤病例.方法 回顾解放军总医院2016年12月收治的1例胃癌卵巢转移患者临床病理及影像学资料,总结分析其影像学特殊性及鉴别诊断方法.结果 本例患者以“腹部可触及性包块”为首发症状,于解放军总医院明确诊断为“胃癌,库肯勃格瘤”并行手术治疗.术前影像学检查提示双侧卵巢呈现“晕环征”、“轨道征”、“管状征”等特殊征象.结论 库肯勃格瘤影像学上常表现为结节状或分叶状实性肿瘤,本例库肯勃格瘤影像形态特殊,对于库肯勃格瘤的诊断及鉴别诊断具有重要参考意义.

Objective To discover frequently mutated new gastric cancer-related genes by exome sequencing technology and to analyze mutated their relationships with different clinicopathological phenotypes of gastric cancer.Methods Tumor samples of gastric cancers and preoperative peripheral blood samples from 30 patients were collected respectively from January to March,2016 in the department of general surgery,Chinese PLA General Hospital.Exome sequencing on samples were performed.Using peripheral bloods as control,mutations in tumor samples were discovered by Mutect and Varscan.Frequently mutated gastric cancer-related genes were defined as genes mutated more frequently than TP53.Difference between the mutant and wild-type of certain genes were compared on common clinicopathological phenotypes,such as age,gender,tumor position,differentiation,metastasis lymph nodes,etc.Results There were 27 frequently mutated genes were founded,most of which showed no relationship with clinicopathological phenotypes of gastric cancer.Cases with mutant and wild-type TAS2R43 showed statistically significant difference in gastric body cancer (55.6％ vs 9.5％,P =0.022).Cases with mutant and wild-type ANKRD36C showed statistically significant difference in gastric body cancer (62.5％ vs 9.1％,P =0.005).Cases with mutant and wild-type ANKRD36 showed statistically significant difference in proximal gastric cancer (8.33％ vs 44.4％,P =0.049).Cases with mutant SYNE1 suffer from less metastatic lymph nodes than those with wild types(2.1 ±2.4 vs 8.8 ±9.5,P =0.006).Cases with mutant ADAR are younger than those with wild types(50.7 ± 11.5 year vs 64.0 ± 9.8 year,P =0.006).Conclusion Mutant TAS2R43,ANKRD36 and ANKRD36C were related to location of gastric cancer.Mutant SYNE1 was related to gastric cancer with less lymph nodes metastasis.Mutant ADAR may lead to gastric cancers in younger groups.

目的 探讨胃癌患者行3D腹腔镜根治性全胃切除术后早期经口进食的安全性、可行性及近期临床效果.方法 回顾性收集本院2017年3月-2018年3月收治并行3D腹腔镜根治性全胃切除术的胃癌患者临床资料,根据术后经口进食时间,分为早期经口进食组(术后第1天)和常规进食组(经肛门排气后),并根据性别、年龄、体质量指数、TNM分期和肿瘤分化程度进行严格配对,匹配后共134例患者纳入分析,其中早期经口进食组和常规进食组各67例.比较两组患者术后胃肠功能恢复时间、术后早期营养状况、经口进食耐受情况及术后并发症发生率.结果 与常规进食组相比,早期经口进食组术后首次排气时间[(2.66±1.38)d ys(3.37±1.19)d,P=0.000]和首次排便时间[(3.46±1.41)d vs (4.52±1.26)d,P=0.012]更早;术后住院时间更短[(6.51±1.53)d ys(8.62±1.48)d,P=0.000],住院费用更少[(1.74±0.51)万元vs (2.12±0.83)万元,P=0.012];术后第6天血清前白蛋白水平[(177.6±33.1) mg/L vs (149.4±25.3) mg/L,P=0.016]及血清白蛋白水平[(37.3±3.1) g/L vs (34.1±3.5) g/L,P=0.011]更高;两组术后重新置入鼻胃管率及吻合口瘘等并发症发生率均无统计学差异(P均＞0.05).结论 胃癌患者3D腹腔镜根治性全胃切除术后早期经口进食能够促进肠道功能恢复,改善术后营养状态,减少住院时间和住院费用,不增加术后并发症发生率,是安全可行的.

目的 回顾分析普通外科患者不同感染部位的主要病原菌的分布及耐药性,为早期 、合理开展经验性治疗提供参考.方法 收集2012年1月-2016年1月医院普通外科收治的397例感染患者的感染组织 、痰与腹腔引流及穿刺液标本,对感染患者标本进行病原菌的分离培养鉴定及药敏试验,观察分析病原菌的种类 、分布及耐药性.结果 397例感染患者标本共培养出病原菌64种共计723株;其中感染组织中分离病原菌398株占55.05％,以大肠埃希菌 、肺炎克雷伯菌 、粪肠球菌为主;痰标本中共分离病原菌213株占29.46％,以肺炎克雷伯菌 、铜绿假单胞菌及鲍氏不动杆菌为主;腹腔引流及穿刺液标本中共分离病原菌112株占15.49％,以大肠埃希菌和肺炎克雷伯菌为主;肺炎克雷伯菌 、大肠埃希菌对亚胺培南及美罗培南均高度敏感;鲍氏不动杆菌多药耐药严重;粪肠球菌及屎肠球菌对万古霉素耐药率均为0.结论 普通外科感染患者的病原菌以革兰阴性菌为主,对碳青霉烯类抗菌药物敏感,应依据病原菌分布特点及药敏试验结果合理选择抗菌药物.

Objective To obtain active purified GST-HDAC6 protein by cloning histone deacetylase 6 (HDAC6) .Methods The coding sequence of HDAC6 was amplified by PCR from human mammary cDNA library, and inserted into the prokaryotic expression vector pGEX-KG.The fusion protein was purified by GST-Sepharose 4B beads, and then identified by SDS-PAGE and Western blot analysis.The biological activity of purified GST-HDAC6 protein was detected by deacetylation experiment.Results From human breast cDNA library, we got a 3645-bp fragment and cloned it into pGEX-KG carrier successfully of which the sequence was in complete accord with target sequence.The target protein expressed by the sequence was with a molecular weight of 170 000 (Mr) from e.coli DH5α.Then, we obtained the highly purified fusion protein GST-HDAC6 after purification.By deacetylation experimental verification, we found the protein showed great enzyme activity.Conclusion HDAC6 is successfully cloned and the active fusion protein is purified, which provide experimental basis for research in relationship between deacetylases and tumor.

OBJECTIVE To compare the short-term outcomes between robotic and laparoscopic radical total gastrectomy in gastric cancer patients with BMI index ≥24 kg/m2. METHOD Clinical data of 93 gastric cancer patients who underwent robotic and laparoscopic radical total gastrectomy at PLA General Hospital from April 2016 to April 2017 were retrospectively analyzed. The retrospective cohort study was adopted. INCLUSION CRITERIA preoperatively definite diagnosis of primary gastric cancer by endoscopy and biopsy; preoperative BMI ≥24 kg/m2; no previous abdominal surgery; no previous chemotherapy and radiotherapy; no distant metastasis or invasion into adjacent organs before operation or during operation; receiving radical gastrectomy; Roux-en-Y reconstruction of digestive tract in open procedure. According to approaches of minimally invasive surgery, 24 patients underwent robotic surgery and 69 underwent laparoscopic surgery. The intraoperative parameters (overall operative time, pneumoperitoneal time, open procedure time, intraoperative blood loss, transfusion rate, number of total retrieved lymph nodes and metastatic lymph nodes) and postoperative parameters (drainage in the first postoperative day, the first defecation time, morbidity of postoperative complication and hospital stay) were compared between two groups. Correlation of the above parameters were analyzed. RESULTS Of 93 patients, 77 were male and 16 female with an average age of (60.0±10.6) years. The average BMI was (26.8±1.3) kg/m2 in whole patients, (26.9±1.6) kg/m2 in robotic group and (26.8±1.7) kg/m2 in laparoscopic group. No significant differences in age, gender, BMI, preoperative ASA class, postoperative pathological findings and clinical classification were observed between two groups, which made short-term parameters between two groups comparable. The robotic group had a significantly longer overall operative time [(301.2±68.9) minutes vs. (247.3±59.6) minutes, P=0.000], longer open procedure time [(141.5±26.3) minutes vs. (92.5±36.7) minutes, P=0.029] and higher cost than laparoscopy group[(17.5×104 ± 9.7×104) yuan vs. (10.0×104 ± 2.3×104) yuan, P=0.001]. Pneumoperitoneal operative time, intraoperative blood loss, transfusion rate, number of total retrieved lymph nodes, number of harvested metastatic lymph nodes and postoperative short-term efficacy were similar between the two groups (all P>0.05). In robotic group, pneumoperitoneal operative time was positively correlated with overall operative time (r=0.708, P=0.010); total cost was positively correlated with postoperative hospital stay (r=0.493, P=0.000) and open procedure time was negatively correlated with the first defecation time (r=-0.962, P=0.038). In laparoscopy group, total cost was positively correlated with overall operative time (r=0.411, P=0.046), drainage volume in the first postoperative day was positively correlated with the number of total dissected lymph node (r=0.540, P=0.006), postoperative hospital stay was positively correlated with intraoperative blood loss (r=0.574, P=0.003), total cost was positively correlated with intraoperative blood loss and hospital stay (r=0.609, P=0.002; r=0.865, P=0.000), drainage volume in the first postoperative day was positively correlated with BMI (r=0.533, P=0.007). CONCLUSION For gastric cancer patients with BMI ≥24 kg/m2, robotic radical total gastrectomy is associated with longer operative time and higher cost, but is less vulnerable to the change of BMI and more in favor of the realization of enhanced recovery after surgery (ERAS) than laparoscopic radical total gastectomy.

目的 研究达芬奇机器人胃癌根治术的安全性及可行性.方法 该次研究方便选取的研究对象为2013年5月—2014年4月收治的胃癌患者,将70例患者按照入院顺序的单双号分为两组,35例/组.一组患者实施腹腔镜胃癌根治术(腹腔镜组),另一组采用达芬奇机器人手术系统进行胃癌根治术(观察组).对比两组胃癌患者的手术相关情况、术后康复情况、并发症发生率以及术后3年生存率.结果 观察组胃癌患者的手术时间(212.35±29.67)min、术中出血量(100.22±51.45)mL、淋巴结清扫数(29.25±5.67)枚与腹腔镜组进行比较差异有统计学意义(P<0.05);两组胃癌患者之间对比,观察组肿瘤大小(3.65±2.12)cm、近端及远端切缘周径(14.16±2.98)cm、(5.60±1.29)cm、术后康复情况[术后肠道功能恢复时间为(2.87±1.05)d,术后进流食时间为(3.42±1.09)d,住院时间为(7.66±1.45)d]、术后并发症发生率(11.43％)以及术后3年生存率(1年、2年、3年生存率分别为94.29％、80.00％、71.43％)与腹腔镜组对比差异无统计学意义(P>0.05).结论 达芬奇机器人手术系统能够有效治疗胃癌患者,安全有效.