腹腔镜与开腹进展期远端胃癌D2根治术疗效对比

Laparoscopic vs open gastrectomy with D2 lymphadenectomy for advanced distal gastric cancer

目的 比较腹腔镜与开腹D2根治术在进展期远端胃癌治疗中的疗效.方法 选取66例腹腔镜和52例开腹进展期远端胃癌D2根治术患者（分别为腹腔镜组和开腹组）,比较其手术相关指标、术后恢复指标、肿瘤根治性指标、住院费用、术后并发症及随访结果.结果 腹腔镜组患者术后肛门排气、留置导尿及术后住院时间均明显短于开腹组（P＜0.05）,手术时间略长于开腹组（P＜0.05）,而术中出血量、肿瘤大小、清扫淋巴结数目、上切缘距肿瘤距离及下切缘距肿瘤距离与开腹组无明显差异（P ＞0.05）;腹腔镜组患者手术费及住院总费用均高于开腹组（P＜0.01）;腹腔镜组患者术后并发症明显少于开腹组（P＜0.05）,复发及无瘤生存率与开腹组无明显差异（P ＞0.05）.结论 腹腔镜下进展期远端胃癌D2根治术安全、有效、可行性好,且创伤小、恢复快、并发症少.

Objective To compare the laparoscopic to open gastrectomy with D2 lymphadenectomy for advanced distal gastric cancer. Methods One hundred and eighteen patients with advanced distal gastric cancer underwent D2 radical resection, among whom 66 patients received laparoscopic gastrectomy and 52 received open gastrectomy. The parameters related to surgery, postoperative recovery and tumor radical resection, the hospitalization fee, overall morbidity rate and postoperative outcomes were compared between two groups. Results In laparoscopic group the bowel function restoration time, urinary catheter removal time, duration of hospital stay after operation were significantly shorter than those in the open group（P〈O.05）. The operation time of laparoscopic group was longer than that of open group（P〈0.05）. There were no statistically significant differences between two groups in mean operative blood loss,tumor size,number of lymph nodes excised,the upper distal margin and the lower distal margin（P 〉0.05）. The medical cost of laparoscopic group was more expensive than that of open surgery group（P〈0.01）. The overall morbidity rate in laparoscopic operation was lower than that of open surgery group（P〈 0.05）. There were no significant differences in recurrence rate and disease free survival rate between two groups（P 〉0.05）. Conclusion Laparoscopic gastrectomy with D2 lymphadenectomy for advanced distal gastric cancer is a safe, effective, feasible and less invasive surgical modality with early recovery and less morbidity.