腹腔镜胃癌D2根治术218例疗效评价

Efficiency of laparoscopic D2 radical gastrectomy in gastric cancer： experiences of 218 patients

目的探讨腹腔镜胃癌D2根治术的可行性及其疗效。方法2007年1月至2009年3月，对529例胃癌患者施行胃癌D2根治术，其中腹腔镜手术患者（腹腔镜组）218例，开腹手术患者（开腹组）311例。对两组患者的术中及术后情况、淋巴结清扫数目、并发症及病死率等进行比较分析。结果腹腔镜组手术时间为（237±42）min长于开腹组的（229±42）min，而两组术中出血量[（81±100）ml比（171±211）m1]、术中输血例数（7例比44例）、术后胃肠功能恢复时间[（4．1±2．3）d比（5．0±1．4）d]、首次进流质时间[（4．5±2．2）d比（5．5±1．4）d]和术后住院时间[（12±4）d比（14±4）d]等差异均有统计学意义（P〈0．05），腹腔镜组均优于开腹组。在腹腔镜组中，全胃切除术的手术时间为（250±46）min，显著长于远端胃大部切除术的（228±37）min（P〈0．05），而两种术式在其他方面均无显著差异。腹腔镜组和开腹组术后并发症发生率分别为11．9％和19．0％，差异有统计学意义（P〈0．05）。腹腔镜胃癌手术的中转开腹率为6．0％。全组患者平均淋巴结清扫数目为（29±10）枚，中位数为28枚。腹腔镜组和开腹组患者平均淋巴结清扫数目分别为（28±10）枚和（29±9）枚，差异无统计学意义（P〉0．05）。结论腹腔镜胃癌D2根治术具有安全、术后恢复快和并发症少等优点，同时在淋巴结清扫方面能达到与开腹手术相同的效果。

Objective To explore the feasibility and efficacy of laparoscopic D2 radical gastrectomy in patients with gastric cancer. Methods The clinical data of 529 patients with gastric cancer underwent I）2 radical resection from January 2007 to March 2009 were analyzed retrospectively. Among the patients, 218 cases underwent laparoscopic D2 gastrectomy （LAG group） and 311 cases received open gastreetomy （OG group）. The patients＇ operation, number of retrieved lymph nodes, recovery, postoperative morbidity and mortality were compared between the two groups. Results The operative time in LAG group was （237 ± 42） rain, and was significantly longer than that in OG group [ （229 ± 42） rain, P 〈 0. 05 ]. However, the mean blood loss [ （ 81 ± 100） ml vs. （ 171 -± 211 ） ml ], number of patients needed blood transfusion （ 7 vs. 44 cases）, first flatus time [ （4. 1 ± 2. 3 ） d vs. （5.0 ± 1.4 ） d ], time to resume soft diet [ （4. 5 ± 2. 2 ） d vs. （5.5 ±1.4） d] and postoperative hospital stay [（12 ±4） d vs. （14 ±4） d] in the two groups were all different statistically （P 〈 0. 05 ）, and all were better in LAG group. In LAG group, the operative time of patients with total gastrectomy was （250 ± 46 ）min, and was significantly longer than that with distal gastrectomy （228 ± 37 ） rain （ P 〈 0. 05 ）, but there was no significant differences in other aspects of patients＇ recovery between the two operation types. The postoperative morbidity of LAG group and OG group were 11.9% and 19. 0% , respectively （ P 〈 0. 05 ）. For all patients, the mean number of retrieved lymph nodes was （29 ± 10 ） and the median number was 28. The mean number of retrieved lymph nodes was not significantly different between the two groups [ （ 28 ± 10 ） in LAG group vs. （ 29 ± 9 ） in OG group, P 〉 0. 05 ]. Thirteen patients（6.0% ） converted to open surgery in LAG group. Conclusion Laparoscopic D2 radical gastrectomy is a safe and feasible procedure with quick recovery, and it is comparable with open gastrectomy in lymph node dissection.