远端进展期胃癌腹腔镜辅助与开腹根治术的远期疗效比较

A comparative study on laparoscopic-assisted and open distal gastrectomy for advanced gastric cancer

目的探讨进展期胃癌腹腔镜根治术的安全性和可行性，并评价其远期临床疗效。方法对2004年1月至2009年6月远端进展期胃癌行腹腔镜辅助胃癌根治术346例患者的临床及随访资料和同期在我院行传统开腹胃癌手术的313例进行回顾性分析，比较两组的手术安全性、术后并发症、生存率以及癌症复发转移情况。结果腹腔镜组手术平均用时与开腹组相比差异无统计学意义[（211±56）min比（204±41）min，P〉0．05]。腹腔镜组术中出血量、切口长度显著低于开腹手术组。腹腔镜组肿瘤近、远端切缘长度分别为（6．3±2．0）cm、（5．7±1．7）em，开腹组分别为（6．3±2．1）am、（5．6±1．6）cm，两组相比差异均无统计学意义。腹腔镜组淋巴结清扫数量为（33±13）枚，开腹组为（33±16）枚，两组相比差异无统计学意义。腹腔镜组术后并发症的发生率显著低于开腹组（6．7％比13．1％，P〈0．01）。随访时间6～72个月，平均37个月，腹腔镜组1、3、5年生存率分别为87．2％、57．2％和50．3％，开腹组分别为87．1％、54．1％和49．2％，两组相比差异均无统计学意义。两组癌症复发转移率相比差异无统计学意义。结论腹腔镜辅助的进展期胃癌根治术与开腹组在生存率及术后复发方面无显著差异，且具有创伤小、术后恢复快、并发症少等优点。

Objective To evaluate the feasibility, safety and the long-term outcomes of laparoscopy-assisted distal gastreetomy （LADG） for advanced gastric cancer （AGC）. Methods We retrospectively analyzed the clinical and follow-up data of 346 cases after LADG from January 2004 to June 2009, compared with 313 cases after conventional open distal gastreetomy （ODG） for advanced gastric cancer at the same period at our hospital. The surgical safety, postoperative complications, survival rate, and the recurrence and metastasis of cancer were compared. Results There was no significant difference at the average time of LADG and ODG procedures （211 ± 56） min vs. （204 ±41） min, but blood loss during operation and length of incision in LADG group were significantly less than in the ODG group. The proximal and distal length were, respectively, （ 6. 3 ± 2. 0 ） em and （ 5.7 ± 1.7 ） em in LADG group and （ 6. 3 ± 2. 1 ） cm and （5.6 ±1.6） cm in ODG group, the difference was not significant. The number of lymph node dissections was also similar： （33 ± 13） in LADG group and （33 ± 16） in ODG group. The incidence of postoperative complications in LADG group was significantly lower than that in ODG group （ 6. 7% vs. 13.1%, P 〈0. 05）. During the follow-up period of 6 -72 months （ average 37 months） , the 1-, 3- and 5- year survival rates were, respectively, 87. 2% , 57. 2% and 50. 3% in LADG group and 87.1% , 54. 1% and 49. 2% in ODG group, the difference was not significant. The differences in recurrence and metastasis between the two groups were not statistically significant. Conclusion Laparoscopy-assisted gastrectomy for advanced gastric cancer is not significantly different with open surgery in postoperative survival rate or recurrence. It is less traumatic and of fewer complications.