腹腔镜辅助胃癌根治术淋巴结清扫效果的临床对照研究

Effect of laparoscopy assisted vs. open radical gastrectomy on lymph node dissection in patients with gastric cancer

目的探讨腹腔镜辅助胃癌根治术中淋巴结清扫的可行性及临床效果。方法2007年1月至2010年5月，对934例胃癌患者施行根治性手术（R0切除），其中行腹腔镜手术患者（腹腔镜组）506例，行开腹手术患者（开腹组）428例。对比两组患者淋巴结清扫数目的差异，并分析两组淋巴结清扫数目与术后并发症发生率的关系。结果全部患者平均淋巴结清扫数目为（29±10）枚／例，两组平均淋巴结清扫数目相似（P〉0．05），但腹腔镜组No．7、8组淋巴结清扫数目明显多于开腹组（P〈0．05）。按浸润深度分层分析，除pT3期腹腔镜组平均淋巴结清扫数目多于开腹组外，pTl-2期差异无统计学意义（P〉0．05）；按淋巴结清扫范围和胃切除方式分层分析，腹腔镜组平均淋巴结清扫数目均与开腹组相当（P〉0．05）；按手术时期分层分析，≤50例腹腔镜组平均淋巴结清扫数目少于开腹组（P〈0．05），51-100例和≥101例则与开腹组相当（P〉0．05）。腹腔镜组并发症发生率为11．1％，明显低于开腹组的20．1％，但两组淋巴结清扫数目与术后并发症的相关性均无统计学意义（P〉0．05）。结论随着腹腔镜外科医师技术逐渐成熟，腹腔镜胃癌根治手术能够达到与开腹手术相当的淋巴结清扫效果；合理增加腹腔镜辅助胃癌根治术的淋巴结清扫数目不会增加术后并发症发生率。

Objective To explore the feasibility and efficacy of laparoscopy assisted radical gastreetomy on lymph node （ LN ） dissection for gastric cancer and to compare it with open gastrectomy. Methods The clinical data of 934 patients with gastric cancer underwent radical resection from January 2007 to May 2010 were analyzed retrospectively. Among the patients, 506 cases received laparoscopy assisted gastrectomy （LAG group） and 428 cases received open gastrectomy （OG group）. The number of retrieved LNs and the survival curve between the two groups was compared. Then, the relations between the number of dissected LNs and postoperative morbidity were analyzed. Results For all patients, the mean number of dissected LNs was 29 ±10, there was no significantly differences between LAG group and OG group（P 〈0. 05）. While the number of the retrieved No. 7, 8 LNs in LAG group were significantly more than those in OG group. No significant differences was found in the number of dissected LNs for the pTI-2 stages tumors between the two groups, but significantly greater number of LNs was harvested by LAG group in pT3 stage （P 〈 0.05 ）. No significant differences were found in the number of dissected LNs in different gastrectomy types or extents of LN dissection between the two groups. In the first 50 cases, there were less dissected LNs in LAG group than that in OG group, while 51 cases later, there was no significantly differences in number of dissected LNS between the two groups （ P 〉 0. 05 ）. The postoperative morbidity of LAG group and OG group was 11.1% and 20. 1%, respectively （P 〈0. 05）, but there was no significant correlations between the number of dissected LNs and postoperative morbidity in both groups. Conclusions With the improvement in surgical skills, laparoscopy-assisted radical gastrectomy with lymph node dissection is a safe and feasible procedure, and it is oncologically compatible with open gastrectomy. Suitable increment of dissected LN count would not increase the postoperative complication rate.