腹腔镜辅助胃癌根治术与开腹胃癌根治术对远端进展期胃癌的临床疗效对比研究

Comparative study on radical gastrectomy with laparoscopy-assisted and laparotomy for advanced gastric cancer

目的 探讨腹腔镜辅助胃癌根治术和开腹胃癌根治术对远端进展期胃癌的疗效差异.方法 选取2012年1月至2013年1月于山西省肿瘤医院行腹腔镜辅助远端进展期胃癌根治术的36例患者（腹腔镜组）与同期行开腹远端进展期胃癌根治术的34例患者（开腹组）的临床资料进行回顾性分析.比较2组患者手术切口长度、手术时间、术中出血量、术后肛门首次排气时间、首次进食时间、术后住院时间、淋巴结清扫数目、术后并发症、术后病理诊断及随访情况.结果 与开腹组比较,腹腔镜组手术切口长度更短[（6.1 ±0.4）cm比（18.4 ±0.9）cm],手术时间更长[（254±29） min比（137±16） min],术中出血量更少[（85 ±26） ml比（139±34）ml],术后肛门首次排气时间更短[（3.3±0.6）d比（4.0±1.0）d],首次进食时间更短[（2.7±0.6）d比（5.2±0.6）d],差异均有统计学意义（均P ＜0.05）.腹腔镜组发生肺部感染1例;开腹组发生切口脂肪液化、胃瘫、肺部感染各1例.2组患者切除标本上、下切缘均未见癌组织.腹腔镜组1例因脑出血死亡,1例肝转移,开腹组1例肝转移,1例双肺转移,余患者复查均未发现转移及复发征象.结论 腹腔镜辅助远端进展期胃癌根治术与开腹手术相比,具有手术创伤小、患者痛苦较小、术中出血少、术后恢复快等优势,且根治效果相当,是进展期胃癌的一种安全有效的治疗方法.

Objective To compared the effect of radical gastrectomy with laparoscopy-assisted and laparotomy in advanced gastric cancer.Methods Totally 70 patients with advanced gastric cancer from January 2012 to January 2013 were enrolled and divided into laparoscope group （36 cases） who underwent laparoscopy-assisted radical gastrectomy and laparotomy group （34 cases） who underwent open distal gastrectomy.The incision length,length of operation time,blood loss,time of gastrointestinal recovery and oral intake,length of hospitalization,number of lymph nodes dissected,postoperative complications,postoperative pathology,and follow-up were analyzed and compared between the two groups.Results Compared with laparotomy group,laparoscope group had shorter incision [（6.1 ± 0.4） cm vs （18.4 ± 0.9） cm],longer operation time [（254 ± 29） min vs （137 ±16） min],less blood loss [（85 ± 26） ml vs （139 ± 34） ml],less time spending in gastrointestinal recovery and oral intake group [（3.3 ± 0.6） d vs （4.0 ± 1.0） d,（2.7 ± 0.6） d vs （5.2 ± 0.6） d],with significant differences （all P 〈 0.05）.There were 1 case of pulmonary infection in laparoscope group,1 case of incision fat liquefaction,1case of gastroplegia and 1 case of pulmonary infection in laparotomy group.No cancer tissue was found on the cutting edge in both the two groups.One case in laparoscope group was dead due to cerebral hemorrhage.There was 1 case of hepatic metastasis in laparoscope group,1 case of hepatic metastasis and 1 case of pulmonary metastasis in laparotomy group.Conclusion Laparoscopy-assisted radical gastrectomy is safe in the advanced gastric cancer,with minimal trauma,less blood loss,less pain,faster recovery and similar efficacy compared with laparotomy.