腹腔镜与开腹胃癌根治术D2淋巴结清扫的比较研究

Comparison between Laparoscopy-assisted and Conventional Open Radical Resection of Gastric Cancer with D2 Lymph Node Dissection

目的探讨腹腔镜下胃癌根治术D2淋巴结清扫的可行性。方法回顾性分析我科2007年1月～2009年3月手术治疗的110例胃癌的临床、病理资料。7例伴有远处转移,1例行腹腔镜下胃局部切除未行D2淋巴结清扫,根据排除标准予以剔除。其余102例行胃癌根治术(D2淋巴结清扫),包括近端胃大部切除+D2清扫术(PG+D2)25例,远端胃大部切除+D2清扫术(DG+D2)60例,全胃切除+D2清扫术(TG+D2)17例。102例根据手术方式分为腹腔镜组38例,开腹组64例。结果腹腔镜组清扫淋巴结数目(22.2±9.9个)与开腹组(23.4±9.4个)比较,差异无显著性(t=-0.651,P=0.514)。三种术式腹腔镜组清扫淋巴结数目与开腹组比较[PG+D2:19.4±7.3(n=8)vs21.2±8.5(n=17);DG+D2:20.9±10.8(n=22)vs22.2±8.0(n=38);TG+D2:28.3±7.5(n=8)vs32.8±12.1(n=9)],差异均无显著性(t=-0.517,-0.526,-0.913;P=0.610,0.601,0.375)。结论腹腔镜下胃癌根治D2淋巴结清扫是可行的,清扫淋巴结数目和开腹手术类似,能够符合肿瘤根治原则。

Objective To evaluate the feasibility of laparoscopic radical resection of gastric carcinoma with D2 lymph node dissection,and compare its efficacy with conventional open radical surgery.Methods The clinical and pathological data of 110 patients with gastric cancer,who received treatment in our hospital of from January 2007 to March 2009,were analyzed retrospectively.Among the cases,8 were excluded because of distant metastasis（7 cases）or regional resection being performed（1 case）.In the other 102 patients,radical proximal gastrectomy（PG＋D2）was performed in 25 cases,radical distal gastrectomy（DG＋D2）in 60 cases,and radical total gastrectomy（TG＋D2）in 17 cases.In these cases,38 cases were in laparoscopic-assisted group and 64 in open group.Results No significant difference was found in the number of resected lymph nodes between the two groups（laparoscopic-assisted group vs open group：22.2±9.9 vs 23.4±9.4,t=-0.651,P=0.514）,no matter which operation the patients underwent [PG＋D2：19.4±7.3（n=8）vs 21.2±8.5（n=17）;DG＋D2：20.9±10.8（n=22）vs 22.2±8.0（n=38）;TG＋D2：28.3±7.5（n=8）vs 32.8±12.1（n=9）;t=-0.517,-0.526,and-0.913;P=0.610,0.601,and 0.375,respectively].Conclusions Laparoscopic radical resection of gastric cancer with D2 lymph node dissection is a feasible surgical procedure and can satisfy oncologic criteria.