腹腔镜辅助与开腹胃癌根治术的比较

Case-matched Controlled Trial of Laparoscopic-assisted Surgery and Open Surgery for Carcinoma of Stomach

目的比较腹腔镜与传统开腹胃癌根治术在胃癌治疗中的近期效果。方法2002年3月～2005年12月因胃癌而在我中心行腹腔镜手术33例和同期在我院行传统开腹手术33例进行对照研究。比较2组的手术相关指标、术后恢复、肿瘤根治程度。结果2组均无切缘癌残留、肠漏和手术死亡病例。腹腔镜组手术时间显著长于开腹组（中位数340min vs 240min，Z=2．172，P=0．030）。在术后使用止痛剂腹腔镜组优于开腹组[（1．1±1．5）次vs（2．8±1．9）次，Z=4．03，P=0．01]，而术中出血量（中位数200ml vs 257ml，Z=1．458，P=0．145）、术中输血量、术后血常规、肝功能变化、淋巴结清扫数目[（15．8±8．4）枚vs（14．3±9．0）枚，t=0．700，P=0．487）2组差异无统计学意义（P〉0．05）。结论腹腔镜辅助胃癌根治术安全、有效，近期效果可达到传统开腹效果，可在临床推广应用。

Objective To compare short-term effects between laparoscopic-assisted and open radical gastrectomy. Methods The clinical data of 33 cases performed by laparoscopic-assisted surgery （Laparoscope Group） from March 2002 to December 2005 and 33 cases performed by open surgery（ Open Group） at the same period in our center were compared. Operationrelated index,postoperative recovery and extent of radical resection of tumors in the 2 groups were compared. Results No case had residual tumor in incisal margin, intestine leakage and operation death in the 2 groups. Operation time in the Laparoscope Group was significantly longer than that in the Open Group （ median 340 rain vs 240 rain, Z = 2. 172, P = 0.030）. Postoperative administration of anodyne in the Laparoscope Group surpassed that in the Open Group（ 1.1 ± 1.5 times vs 2.8 ± 1.9 times, Z = 4.03, P = 0.01 ） , but intraoperative blood loss （median 200 ml vs 257 ml, Z = 1. 458 , P = 0. 145 ） , and blood transfusion, blood routine and hepatic function before and after operation, clearance number of lymph nodes（ 15.8 ± 8.4 vs 14.3 ± 9.0, Z = 0. 114, P = 0. 909 ） had no significant difference between the 2 groups（ P 〉 0.05 ）. Conclusions Laparoscopic-assisted radical gastrectomy for gastric cancer is safe and effective, and its short-term outcome is similar to open surgery.