腹腔镜与开腹远端胃癌根治术同期临床对比研究

Comparison of laparoscopy assisted vs open radical distal gastrectomy for gastric cancer

目的比较腹腔镜辅助下远端胃癌根治及D2淋巴结清扫术的手术方法、可行性及安全性。方法对2004年3月至2005年5月行腹腔镜胃癌根治术44例及传统开腹手术58例病人的手术安全性、术后恢复及肿瘤根治性进行比较分析。结果腹腔镜组44例病人中43例成功完成腹腔镜手术,其中行D1+α淋巴结清扫6例,D1+β2例,D2及D2+手术35例,平均清扫淋巴结(30·11±16·97)枚,1例因胃左动脉根部淋巴结融合包绕血管而中转开腹手术。腹腔镜组手术平均用时长于开腹组[(282·84±32·81)vs(223·75±23·25)min]。腹腔镜组术中出血、切口长度、术后止痛剂注射次数以及术后肛门排气时间、下床时间分别为(139·30±82·67)mL,(5·61±0·81)cm,(1·02±1·03)次,(4·10±0·75)d,(3·24±0·777)d,显著低于开腹手术组。腹腔镜组肺部感染率低于开腹组,但差异无显著性,两组间其他并发症差异无显著性。腹腔镜组肿瘤近或(远)端切缘、淋巴结清扫数量、第一及二站淋巴结转移阳性率分别为(6·05±1·27)cm、(6·37±1·12)cm、(30·11±16·97)、47·7%及31·8%,与开腹组相比差异无显著性。术后近期随访效果良好。结论腹腔镜胃癌根治术较传统开腹手术耗时长,但能达到与开腹胃癌标准根治术(D2)相同的淋巴结清扫范围及肿瘤切缘,且具有创伤小、出血少、安全、术后恢复快等优点。

Objective To investigate the feasibility, safety and cancer clearance of laparoscopic distal gastrectomy with D2 lymphadenectomy. Methods We compared the safety, recovery, complications, oncological clearance and short-term outcomes of two groups of patients with gastric cancer who underwent either radical laparoscopy assisted or open distal gastrectomy from march 2004 to May 2005 （ including 44 and 58 cases in each group）. Results Except for 1 case of conversion to open surgery, the other 43 patients underwent laparoscopy-assisted distal gastrectomy successfully, accompanied by D1^＋αlymphadenectomy in 6 cases,D1^＋β in 2 cases and D2/D2^＋in 35 cases,with a mean number of total retrieved lymph nodes of 30. 11 ± 16. 97. The mean operation time for laparoscopic distal gastrectomy was significantly longer than that for open surgery （ 282. 84 ± 32. 81 vs 223.75 ± 23.25 rain ）. The mean blood loss, length of incision, times of analgetic injection,first flatus time and time to ground activity in laparoscopic group was 139.30 ± 82. 67mL,5.61 ± 0. 81cm, 1.02 ± 1.03,4. 10 ± 0.75 d,3.24 ± 0. 77d respectively, which was significantly lesser or shorter than those in open group. The complication rate was comparable in two groups. No significant difference between two groups was observed for cancer clearance, in terms of number of lymph nodes removed and length of proximal and distal margin to the tumor. Conclusion In spite of being time comsuming as compared with open surgery, laparoscopy-assisted radical gastrectomy with D2 lymphadenectomy is a safe, feasible procedure, which achieves the same cancer clearance as open surgery and leads to quick postoperative recovery.