腹腔镜辅助胃远端癌淋巴结清扫术近期疗效

Short-term efficacy of laparoscopy-assisted distal gastrectomy with lymph node dissection in distal gastric cancer

目的探讨腹腔镜辅助胃远端癌D2淋巴结清扫术的可行性及近期疗效。方法2007年1月至2008年12月，对241例胃远端癌患者施行D2淋巴结清扫术。其中腹腔镜辅助远端胃大部切除术（LADG组）93例，常规开腹远端胃大部切除术（ODG组）148例。比较两组患者的淋巴结清扫数及术中、术后恢复情况、并发症发生率和住院死亡率。结果LADG组和ODG组患者淋巴结清扫数分别为（27．5±9．1）枚和（27．3±8．5）枚，两组差异无统计学意义（P〉0．05）。按肿瘤浸润深度进行分层分析，T1、T2、T3期患者两组平均清扫淋巴结数差异均无统计学意义（P〉0．05）。LADG组手术时间显著长于ODG组，但术中出血量、输血例数、术后首次下床时间、肛门排气时间、进流质时间、住院时间和手术并发症发生率均显著少于ODG组，两者差异有统计学意义（P〈0．05）。结论腹腔镜辅助胃远端癌D2淋巴结清扫术在淋巴结清扫方面能达到与开腹手术相同的效果，且具有安全、术后恢复快和并发症少等优点。

Objective To explore the feasibility and short-term efficacy of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection. Methods Clinical data of 241 patients of distal gastric cancer undergone D2 lymph node dissection from January 2007 to December 2008 were analyzed retrospectively. Among them, 93 underwent laparoscopy-assisted distal gastrectomy （LADG group）, while 148 underwent open distal gastrectomy （ODG group）. The number of removal lymph node, recovery, complication rate and mortality were compared between two groups. Results The mean number of removal lymph node were not significantly different between two groups（27.5±9.1 in the LADG group vs 27.3±8.5 in the ODG group, P〉0.05）, and there were also no significant difference between two groups in T1,T2,T3 patients according to the subgroup analysis of depth invasion（P〉0.05）. As compared to ODG group, although the operative time was significantly longer,the mean blood loss and transfused patient number were less, ground activity time, first flatus time, resume soft diet time and postoperative hospital stay were shorter, and complication rate was significantly lower in LADG group（all P〈0.05）. Conclusion LADG with D2 lymph node dissection is oncologically compatible with open gastrectomy, and it is a safe and feasible procedure which leads to quick postoperative recovery.