早期胃癌腹腔镜与开腹根治术的对照研究

A comparison of laparoscopy-assisted gastrectomy with open gastrectomy for early gastric cancer

目的:评价腹腔镜胃癌根治术治疗早期胃癌的可行性、安全性、肿瘤根治性以及术后近期疗效。方法:回顾性分析2004年8月至2007年8月间68例接受外科手术的早期胃癌的临床和手术资料,其中腹腔镜胃癌根治术31例,开腹胃癌根治术37例;并比较两组的手术时间、术中出血、术后胃肠道恢复、术后住院天数、术后并发症、术后病理及随访等结果。结果:全部31例早期胃癌均在腹腔镜下完成胃切除和淋巴结清扫,无中转开腹,其中远端胃大部切除术28例,近端胃大部切除术2例,全胃切除术1例;D1+α式淋巴结清扫16例、D1+β式淋巴结清扫2例,D2淋巴结清扫13例。腹腔镜胃癌根治术的平均手术时间为194.8±50.8min,与开腹组无显著性差异;术中出血量(138.7±157.3)ml,显著低于开腹组(P<0.05)。腹腔镜手术后肠道恢复功能时间1.8(1～4)d,显著少于开腹组(P<0.01)。腹腔镜组术后并发症发生率为3.2%,与开腹组无显著性差异(P>0.05)。腹腔镜组清扫淋巴结数(9.6±4.4)枚,测量胃近端和远端正常切缘(3.8±1.6)cm及(3.5±1.3)cm,与开腹组比较无显著性差异。术后中位随访15(2～35)个月,腹腔镜组无肿瘤复发或者死亡,开腹组一例因腹膜复发而死亡。结论:腹腔镜胃癌根治术是治疗早期胃癌安全、可行、微创、有效的方法。

Objective To evaluate the feasibility, safety and therapeutic efficacy of laparoscopy-assisted gastrectomy for early gastric cancer. Methods From Aug. 2004 to Aug. 2007, 31 patients with early gastric cancer underwent laparoscopic assisted gastrectomy （LAP） and the other 37 early gastric cancer patients underwent open gastrectomy （OPEN）. Clinical parameters including surgical procedure, operation time, blood loss, time for passage of flatus, postoperative hospital stay, complications and pathological findings in both groups were compared. Results All patients in the LAP group underwent gastrectomy and lymph nodes dissection successfully without conversion to open surgery; the group included 28 distal gastrectomy, 2 proximal gastrectomy, and 1 total gastrectomy. Sixteen,2 and 13 of the LAP patients received D1＋α, D1＋β, and D2 modes of LN dissection respectively. The mean operation time of the LAP group was （194.8±50.8） min, which was not significantly different from the OPEN group;the blood loss was （138.7±157.3） ml, time for passage of flatus was 1.Sd, which were significantly less than those observed in the OPEN group. One patient （3.2%）of the LAP group died from postoperative peritoneal metastasis. The distances from tumor borderline to distal and proximal resective margins were （3.8±1.6） cm and （3.5±1.3） cm respectively in the LAP group. The average number of lymph nodes dissected with laparoscopic gastrectomy was 9.6±4.4. After 2-35 months of follow-up, no tumor recurrence and metastasis were found in the LAP group. Conclusions Laparoscopy-assisted gastrectomy is a safe, feasible,effective and minimally invasive technique for early gastric cancer.