腹腔镜辅助根治性全胃切除术治疗进展期胃癌

Laparoscopy-assisted D2 total gastrectomy in advanced gastric cancer

目的探讨腹腔镜辅助下D2淋巴结清扫全胃切除术（LATG）的可行性，并与开腹D2淋巴结清扫全胃切除术（OTG）比较。方法2005年7月至2007年3月共125例进展期胃癌患者中59例行LATG，66例行OTG，记录两组的临床资料并进行分析比较。结果59例接受LATG的患者，均无中转开腹，无手术死亡，无严重的手术并发症。与OTG组比较，LATG组手术时间延长[（330±71）min vs／35．（261±54）min，P=0．005]，淋巴结清除数相似（36±13 vs／35．34±16，P=0．450），术中失血量减少[（175±101）ml vs．（359±210）ml，P=0．003]，肠功能恢复较早（P=0．015），术后发热期缩短（P=0．024）。结论对于进展期胃癌，与D2根治性OTG相比，D2根治性LATG安全可行，并具有手术入路好、手术操作空间开阔、术中失血量少以及术后恢复快等优点。

Objective To investigate the efficacy and advantages of laparoscopy-assisted total gastrectomy （LATG） with D2 dissection of lymph nodes versus conventional open D2 total gastrectomy （OTG） in advanced gastric cancer. Methods One hundred and twenty-five patients with advanced gastric cancer in the middle or upper third of the stomach were operated on from July 2005 to March 2007. Of the patients, 59 cases received LATG and 66 OTG with D2 lymph nodes dissection. Clinical data were recorded and compared between the two groups. Results No patient in the LATG group converted to conventional operation with laparotomy. No operation mortality and no severe morbidity occurred in LATG group. As compared with OTG group, in LATG group operation time was longer [ （330 ± 71 ） rain vs. （261±54） min, P = 0. 005 ] in LATG group, but with similar number of lymph node retrieval （36 ± 13 vs. 34 ± 16, P = 0. 450） , less operation blood loss [ （ 175 ± 101 ） ml vs. （ 359 ± 210） ml, P = 0. 003 ] , earlier recovery of bowel activity （ P = 0. 015 ） , and a shorter duration of fever after operation （ P = 0. 024）. Conclusions LATG with D2 lymph node dissection in advanced gastric cancer is safe and technically feasible with better operative access and visual field, less operation blood loss and earlier recovery.