进展期远端胃癌腹腔镜与开腹根治术的对照研究

Comparison of laparoscopy-assisted distal gastrectomy with open gastrectomy for advanced gastric cancer

目的探讨腹腔镜远端胃癌根治术治疗进展期远端胃癌的可行性、安全性及近期疗效．方法回顾性分析2007年1月至2008年6月间135例接受外科手术的远端胃癌患者的临床资料．其中腹腔镜远端胃癌根治术66例．开腹远端胃癌根治术69例。结果腹腔镜组与开腹组患者年龄、性别和TNM分期的差异均无统计学意义（均P〉0．05）。腹腔镜组均在腹腔镜下成功完成根治性胃切除手术，无中转开腹和手术死亡。与开腹组比较，腹腔镜组患者手术时间更长[（266．1±55．1）min比（223．8±26．8）min]；但术中出血量更少[（131．9±88．7）ml比（342．3±178．7）ml]，术后肠道恢复功能更快[（3．18±1．22）d比（4．50±1．59）d]，术后住院时间更短[（9．20±3．39）d比（11．35±4．61）d]；差异均有统计学意义（均P〈0．01）。两组清扫淋巴结数目[（25．81±12．53）枚比（27．47±10．28）枚]和术后并发症发生率[6．1％（4／66）比15．94％（11／69）1的差异均无统计学意义（均P〉0．05）。术后随访1～19个月．两组均未见肿瘤复发或肿瘤相关死亡病例。结论腹腔镜远端胃癌根治术是治疗进展期远端胃癌安全、可行、微创、有效的方法。

Objective To evaluate the feasibility, safety and short-term outcomes of laparoscopy- assisted distal gastrectomy for advanced gastric cancer. Methods From January 2007 to June 2008, 135 patients with advanced gastric cancer in the lower or middle stomach were operated, of whom 66 underwent laparoscopy-assisted distal gastrectomy （LADG） with D2 dissection of lymph nodes and 69 received conventional open D2 distal gastrectomy （ODG）. Clinical data were recorded and compared between the two groups. Results There were no significant differences in age, gender, and TNM staging between LADG and ODG （all P〉0.05）. All the patients in the LADG group underwent gastrectomy and lymph nodes dissection successfully without conversion to open surgery and no operative deaths occurred. The operative time was significantly longer for the LADG group than for the ODG group [ （266.1±55.1 ） min vs. （223.8 ± 26.8） min）]. The patients in the laparoscopic surgery group had less blood loss [ （131.9±88.7） ml vs. （342.3±178.7） ml], earlier recovery of bowel activity [ （3.18±1.22） d vs.（4.50±1.59） d], and shorter hospitalization time[ （9.20±3.39） d vs. （11.35±4.61 ） d]. No significant differences were found in the total number of retrieved lymph nodes （25.81 ±12.53 vs. 27.47±10.28）. The morbidity of complications was comparable between two groups （6.1% vs. 15.94%）. No mortality and recurrence were observed during a follow-up period of 1-19 months. Conclusions LADG with D2 lymph node dissection is a safe and feasible procedure with adequate lymphadenetomy for advanced gastric cancer.