引用文本：李雄, 付广, 吴思鸣, 等. 腹腔镜胃癌常态化手术演示的安全性研究[J/CD]. 消化肿瘤杂志（电子版）, 2026, 18(1): 75-82.

作者：李雄，付广，吴思鸣，余加，陈锡光，肖忠盛，龙泓，黄秋林，肖帅

单位：南华大学附属第一医院胃肠外科，湖南 衡阳 421001

Authors：Li Xiong, Fu Guang, Wu Siming, Yu Jia, Chen Xiguang, Xiao Zhongsheng, Long Hong, Huang Qiulin, Xiao Shuai

Unit：Department of Gastrointestinal Surgery, the First Affiliated Hospital of University of South China, Hengyang 421001, Hunan, China

摘要：

目的　探讨腹腔镜胃癌常态化手术演示的可行性和安全性。方法　采用回顾性队列研究方法，选取2022年12月6日至2024年7月19日在南华大学附属第一医院胃肠外科单一治疗组行手术治疗的139例胃癌患者临床资料，根据是否进行常态化手术演示分为演示组（n=61）与非演示组（n=78）。比较演示组与非演示组患者的基线特征、术中资料、术后病理情况和术后恢复、住院费用等。对演示组病例按开展常态化演示的时间进行分层分析（早期演示组31例和后期演示组30例），对比两组的术前、术中和术后资料。结果　①演示组与非演示组的性别、营养风险筛查2002（nutritional risk screening 2002, NRS 2002）评分、腹部手术史、合并基础疾病、原发肿瘤部位以及术前血红蛋白、白蛋白、白细胞、C反应蛋白（C-reactive protein, CRP）水平等差异均无统计学意义（均P>0.05），但演示组年龄更小（P=0.047）、体重指数（body mass index, BMI）更高（P=0.009）。演示组与非演示组患者的胃切除范围、消化道重建方式、中转开腹手术、手术时间、术中出血量、阳性淋巴结数目、肿瘤最大径、Borrmann分型、pT分期，以及Clavien-Dindo Ⅲ级以上并发症、胸腔积液，术后5 d血红蛋白、白蛋白、白细胞、CRP、最高体温，术后初次排气时间、术后住院时间、住院费用等差异均无统计学意义（均P>0.05），但演示组较非演示组的淋巴结清扫数目更多（P=0.038）、全程腹腔镜比例更高（P=0.002）。②早期演示组与后期演示组的性别、年龄、BMI、术前血红蛋白、白细胞、CRP水平，以及既往腹部手术史、术前合并基础疾病、肿瘤部位等差异均无统计学意义（均P>0.05），但早期演示组的术前NRS 2002评分（P=0.010）和术前白蛋白水平（P=0.002）高于后期演示组。两组的胃切除范围、消化道重建方式、腹腔镜手术类型、淋巴结清扫数目、阳性淋巴结数目、肿瘤最大径、pT分期等差异均无统计学意义（均P>0.05），但后期演示组的手术时间（P＜0.001）、术中出血量（P=0.041）均优于早期演示组。两组术后5 d血红蛋白、白蛋白、白细胞、CRP水平以及Clavien-Dindo Ⅲ级以上并发症、术后初次排气时间、术后住院时间、住院总费用等差异均无统计学意义（均P>0.05），但后期演示组术后5 d最高体温优于早期演示组（P=0.018）。结论　与非演示手术相比，腹腔镜胃癌常态化手术演示的患者选择和手术操作有一定的主观性，但两者的手术安全性、术后恢复及费用方面无明显差异；度过学习曲线后可快速安全地完成手术演示。腹腔镜胃癌手术在经验丰富的中心进行常态化演示是安全可行的。

关键词：胃癌；手术演示；腹腔镜；安全性

Abstract：

Objective  To investigate the feasibility and safety of routine live demonstration of laparoscopic gastrectomy for gastric cancer. Method A retrospective cohort study was conducted. Clinical data of 139 consecutive gastric cancer patients who underwent surgery by a single surgical team in the Department of Gastrointestinal Surgery, the First Affiliated Hospital of University of South China, between 6 December 2022 and 19 July 2024 were included. Patients were divided into a demonstration group (n=61) and a non-demonstration group (n=78) according to whether the operation was performed as a routine live demonstration. Baseline characteristics, intra-operative variables, post-operative pathological findings, recovery parameters and hospitalisation costs between the two groups were compared. Cases in the demonstration group were further stratified into an early-demonstration subgroup (31 patients) and a late-demonstration subgroup (30 patients) according to the chronological sequence of routine demonstrations; peri-operative data were compared between these two subgroups. Result ①There were no statistically significant differences between the demonstration and non-demonstration groups in sex, nutritional risk screening 2002 (NRS 2002) score, history of previous abdominal surgery, comorbidities, primary tumour location, or pre-operative haemoglobin, albumin, white blood cell count and C-reactive protein (CRP) levels (all P>0.05). However, patients in the demonstration group were younger (P=0.047) and had a higher body mass index (BMI) (P=0.009). No statistically significant differences were observed between the two groups in extent of gastrectomy, reconstruction modality, conversion to open surgery, operative time, intra-operative blood loss, number of positive lymph nodes, maximum tumour diameter, Borrmann type, pT stage, Clavien-Dindo grade≥Ⅲ complications, pleural effusion, haemoglobin, albumin, white blood cell count or CRP on post-operative day 5, maximum body temperature, time to first flatus, post-operative hospital stay or total hospital cost (all P>0.05). The demonstration group yielded a higher number of retrieved lymph nodes (P=0.038) and a higher rate of totally laparoscopic procedures (P=0.002). ②The early- and late-demonstration subgroups did not differ significantly in sex, age, BMI, pre-operative haemoglobin, white blood cell count or CRP, history of previous abdominal surgery, comorbidities or tumour location (all P>0.05). The early-demonstration subgroup had higher pre-operative NRS 2002 scores (P=0.010) and albumin levels (P=0.002) than the late-demonstration subgroup. No statistically significant differences were found between the two subgroups in extent of gastrectomy, reconstruction modality, type of laparoscopic procedure, number of retrieved or positive lymph nodes, maximum tumour diameter or pT stage (all P>0.05). However, the late-demonstration subgroup had shorter operative time (P<0.001) and less intra-operative blood loss (P=0.041). The two subgroups did not differ significantly in haemoglobin, albumin or white blood cell count and CRP levels on post-operative day 5, Clavien-Dindo grade≥Ⅲ complications, time to first flatus, post-operative hospital stay or total hospital cost (all P>0.05), but the late-demonstration subgroup had a lower maximum body temperature on post-operative day 5 (P=0.018). Conclusion Compared with non-demonstration surgery, patient selection and technical performance of routine live demonstration of laparoscopic gastrectomy are subject to some degree of surgeon preference. Nevertheless, no significant differences were observed in surgical safety, post-operative recovery or hospital cost. After completion of the learning curve, demonstration cases can be completed rapidly and safely. Routine live demonstration of laparoscopic gastrectomy for gastric cancer is feasible and safe in experienced centers.

Key words：Gastric cancer; Live surgical demonstration; Laparoscopy; Safety

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