进展期胃癌完全腹腔镜与开腹D_2根治手术的对比研究

Comparison of clinical course between totally laparoscopic and open D_2 gastrectomy for advanced gastric cancer

目的探讨进展期胃癌完全腹腔镜D2根治手术的安全性和可行性。方法回顾分析6年间暨南大学附属第一医院普通外科进展期胃癌的完全腹腔镜D2根治手术26例患者(腔镜组)的临床资料,并以开腹手术45例(开腹组)作为对照。结果入选的71例手术均顺利完成。淋巴结清除数在两组间的差别无统计学意义(P>0.05)。腔镜组的手术时间比开腹组长,术中出血量比开腹组少,术后肛门排气时间和术后住院时间均比开腹组短(均P<0.05)。开腹组手术后发生并发症2例,其中吻合口出血1例,吻合口梗阻1例,均经非手术治疗好转;腔镜组手术无并发症发生。腔镜组术后随访4～63个月,失访1例;1,3,5年生存率分别为100%(20/20),92.3%(12/13),66.7%(2/3)。开腹组术后随访3～65个月,失访2例;1,3,5年生存率分别为100%(37/37),90.5%(19/21),71.4%(5/7)。两组间的1,3,5年生存率差别无统计学意义(P>0.05)。结论进展期胃癌的完全腹腔镜D2根治手术是安全、可行的,并体现了腹腔镜手术微创的优越性。

Objective To study the safety and feasibility of totally laparoscopic D2 gastrectomy for advanced gastric cancer. Methods The clinical records of advanced gastric cancer patients who had totally laparoscopic or open D2 gastrectomy over a 6-year period were compared and analysed retrospectively. Results Seventy-one cases were selected in this study, including 26 totally laparoscopic gastrectomy （laparoscopic group ） and 45 open gastrectomy （ open group ）. All the operations were performed successfully. There was no significant difference between these two groups in terms of number of lymph node dissection （ P〉0. 05 ）. The operation time was longer, volume of bleeding was less, and postoperative time of bowel gas passage and hospital stay were shorter in laparoscopic group compared to those in open group （ P 〈0. 05 ）. In open group, 2 cases experienced postoperative complications, including 1 anastomotic bleeding and 1 anastomotic obstruction. This two patients recovered with conservative treatment. No complication was experienced in laparoscopic group. In laparoscopic group, patients were followed up for 4 to 63 months and 1 case was lost,and the 1-, 3- and 5-y survival rate was 100% （20/20）, 92. 3% （12/13）, and 66. 7% （2/3） respectively. In open group, patients were followed up for 3 to 65 months and 2 cases were lost, and 1 -, 3 - and 5 -year survival rate was 100% （ 37/37 ） , 90.5% （ 19/21 ） , and 71.4% （ 5/7 ） respectively. There were no significant differences between these two groups in terms of 1-, 3-, 5-year survival rates （P〉0.05 ）. Conclusions This study reveals that totally laparoscopic D2 gastrectomy is safe and feasible for advanced gastric cancer, and it presents the superior character of minimal invasion.