腹腔镜胃癌根治术与开放性胃癌根治术的对比研究

Comparative study of laparoscopic gastrectomy and open gastrectomy for gastric cancer

目的通过比较腹腔镜下胃癌根治术与开放性胃癌根治术的差异,探讨腹腔镜下胃癌根治性的可行性。方法选取2008年5月至2009年10月行腹腔镜下胃癌根治性切除术81例,其中根治性远端胃癌根治术48例,根治性近端胃癌根治术19例,根治性全胃切除术14例,与开放性胃癌根治术(相同分期)80例的病例资料作回顾性分析。结果 81例均在腹腔镜辅助下完成手术,D1淋巴结清扫6例,D2淋巴结清扫75例。腹腔镜手术和开放性手术的平均手术时间分别为258min和193min(P<0.05),术中平均出血量分别为292ml和389ml(P<0.05),清扫淋巴结平均数分别为16.5枚和17.8枚(P>0.05);术后平均胃肠功能恢复时间分别为2.9天和3.9天(P<0.05);腹腔镜手术组术中无脏器损伤,术后无出血、吻合口漏及肺部感染等并发症,无手术死亡病例。结论腹腔镜下胃癌根治术安全、可行,与开放性胃癌根治术具有相同的淋巴结清扫范围。

Objective The aim of the current study was to compare the operative outcomes and adequacy between resection of laparoscopic gastrectomy and open gastrectomy for gastric cancer.Methods The clinical course of 81 consecutive patients who underwent minimally invasive gastrectomy（n=48）,esophagogastrectomy（n=19） and total gastrectomy（n=14） for gastric cancer was compared with that of patients who underwent open gastrectomy.Main outcome measures included operative time,blood loss,length of stay,morbidity,adequacy of lymphadenectomy and resection margins.Results There was no conversion to laparotomy in the laparoscopic group.It was significantly lower in intraoperative blood loss（292 vs.389 ml） in the laparoscopic group.It was significantly prolong in mean operative time（258 vs.193min） in the laparoscopic group.There was no significant difference in the number of lymph nodes harvested（16.5 vs.17.8 nodes） between the 2 groups.The average time of recovery of gastrointestinal function after surgery were 2.9 days and 3.9 days in two groups（P0.05）.Resection margins were negative in all patients.Conclusion Laparoscopic gastrectomy is feasible and safe for patients with gastric cancer and can be performed safely with adequate lymphadenectomy compared with open gastrectomy.