开腹与腹腔镜辅助远端胃癌根治术的临床对比研究

目的:对比开腹与腹腔镜辅助远端胃癌根治术的手术效果、围手术期恢复情况及预后,探讨腹腔镜辅助远端胃癌根治术的可行性及安全性。方法:选取2011年1月至2012年12月行远端胃癌根治术(远端胃切除+D2淋巴结清扫)的216例患者其分为两组,观察组行腹腔镜手术(n=104),対照组行开腹手术(n=112)。対比研究两组间的肿瘤生物学行为、手术时间、术中出血、术中淋巴结切除数量、术后胃肠道功能恢复时间、术后下床活动时间、术后并发症、住院时间、3年无瘤生存率。结果:两组在肿瘤生物学行为方面差异无统计学意义。观察组手术时间明显长于对照组(P0.05),术中出血量、淋巴结清扫数量、术后排气时间、术后下床活动时间及住院时间均优于对照组,差异有统计学意义(P0.05);术后并发症按Clavien-Dindo法分级并进行対比两组间差异无统计学意义(P0.05);3年无瘤生存率两组差异无统计学意义(P0.05)。结论:腹腔镜辅助下远端胃癌根治术是安全、可行的,与传统手术相比,在术中出血量、淋巴结清扫数量、术后恢复方面具有明显优势。

Clinical comparative study of laparoscopy-assisted and open distal gastrectomy for gastric cancer

Objective:To compare the curative effect,perioperative recovery and prognosis of laparoscopy-assisted distal gas-trectomy (LADG) and open distal gastrectomy (ODG) for gastric cancer and evaluate the feasibility and the security of the LADG. Methods:The study performed a retrospective study on 216 patients who underwent LADG ( n=104 ) or ODG ( n=112 ) for gastric cancer between Jan. 2011 and Dec. 2012. The clinicopathological parameters,time of the operation,operative blood loss,harvested lymph nodes,postoperative exhaust time,postoperative ambulation time,postoperative complications,hospital stay,and recurrence free survival rate for 3 years were compared. Results:No significant differences were observed in clinicopathological parameters between the two groups. The LADG group had significantly less blood loss,more harvested lymph nodes,faster postoperative exhaust time and postopera-tive ambulation time,shorter hospital stay and longer operative time (P<0. 05). The severity of complications,according to the Clavien-Dindo classification,was similar in both groups. There was no significant difference in the recurrence free survival rate for 3 years be-tween the 2 groups. Conclusions:LADG has obvious advantages in blood loss,harvested lymph nodes and postoperative recovery time compared with conventional surgery. LADG is feasible and safe for the treatment of gastric cancer.