进展期胃癌腹腔镜辅助与开腹D_2根治术的对照研究

Comparison of laparoscopy-assisted D_2 gastrectomy with open D_2 gastrectomy for advanced gastric cancer

目的探讨腹腔镜辅助D2根治术治疗进展期胃癌的安全性、可行性和疗效。方法回顾分析2009年3月至2011年12月该院223例行手术治疗的进展期胃癌患者的临床资料,其中腹腔镜辅助D2根治术116例(腔镜组),开腹D2根治术107例(开腹组);比较两组的手术时间、术中出血量、术后胃肠道恢复、术后疼痛、术后住院时间、术后并发症、淋巴结清扫数目及疗效。结果两组病例均顺利完成手术,腔镜组无中转开腹。两组手术时间、术中出血量、淋巴结清扫数目和术后并发症发生率比较差异无统计学意义(P>0.05);腔镜组术后胃肠道恢复和术后住院时间均比开腹组短(P<0.05),术后疼痛也较轻(P<0.05);两组术后2年生存率差异无统计学意义(P>0.05)。结论腹腔镜辅助D2根治术治疗进展期胃癌是安全、可行和微创的,2年生存率无差别,但远期疗效尚待进一步观察。

Objective To investigate the feasibility and security of laparoscopy-assisted D2 gastrectomy for treating advanced gastric cancer.Methods The clinical data of 223 patients with advanced gastric cancer treated by gastroscopic-assisted D2 gastrectomy or open D2 gastrectomy between Mar.2009 and Dec.2011 were analyzed.Among them,116 cases treated by laparoscopy-assisted D2 gastrectomy（laparoscopic group）,and 107 cases treated by open D2 gastrectomy（open group）.Clinical parameters including operation time,blood loss,pain,time for passage of flatus,postoperative hospital stay,complications,the number of lymph nodes dissected and survival rate between groups were compared.Results All operations were successful and no conversion to open surgery in laparoscopic group.No significant difference between two groups was observed in the operation time,blood loss,complications and the number of lymph nodes dissected（P〉0.05）.Patients in laparoscopic group had quicker recovery and lower degree of pains（P0.05）.Conclusion Laparoscopy-assisted D2 gastrectomy for treating advanced gastric cancer is a safe,feasible and minimally invasive technique.However,the long-term effects need further analysis.