腹腔镜辅助胃癌D2根治术并发症的防治

Postoperative complications of laparoscopy-assisted D2 radical total gastrectomy for gastric cancer

目的探讨腹腔镜辅助胃癌D2根治术并发症的防治及其临床价值。方法回顾性分析我院2010年1月至2011年12月分别接受腹腔镜全胃切除胃癌D2根治术（腹腔镜组165例）及开腹全胃切除胃痛D2根治术（开腹组193例）共358例胃癌患者的临床资料。将手术情况、术后恢复情况和并发症进行比较。结果腹腔镜组中位手术时间为225（195—340）min，开腹组为230（195～300）min，两组之间相比差异无统计学意义（P〉0．05）；腹腔镜组淋巴结清扫数日为（26±4）枚，开腹组为（27±4）枚，两组之间相比差异无统计学意义（P〉0．05）；腹腔镜组巾位术中失血量为160（80～600）ml，显著低于开腹组的270（150～600）ml，两组相比差异有统计学意义（P〈0．01）；腹腔镜组术后平均住院（11．4±2．6）d，显著低于开腹组的（13．7±2．4）d，两组相比差异有统计学意义（P〈0．01）。腹腔镜组的术后并发症共18例，开腹组共30例，两组之间相比差异无统计学意义（P〉0，05）。两组均无围手术期死亡病例。结论腹腔镜辅助胃癌D2根治术是安全可行的，并能有效地防治手术的并发症，更能体现创伤小、并发症少、恢复快的特点。

Objective To evaluate postoperative complications of laparoscopy-assisted D2 radical total gastrectomy for gastric cancer as compared with open procedures. Methods In this study, 358 patients of gastric cancer undergoing laparoscopy-assisted D2 total gastrectomy or open D2 total gastrectomy between January 2011 and December 2012 were retrospectively reviewed and analyzed. Patients were non-randomly divided into laparoscopic group （ LAP, n = 165 ） and open surgery group （ OPEN, n = 193 ）. Operative time,intraoperative blood loss, postoperative hospital stay and complications were compared between the two groups. Results Operative time [ 225 （ 195 - 340 ） min vs. 230 （ 195 - 300） rain, P 〉 0. 05 ] and number of lymph nodes dissected [ （26 ± 4） vs. （27 ± 4）, P 〉 0.05 ] between the LAP group and the OPEN group were not significantly different. Compared with OPEN group, blood loss in the LAP group was less [ 160 （ 80 - 600 ） ml vs. 270 （ 150 - 600） ml, P 〈 0. 01 ] and postoperative hospital stay was shorter [ （ 11.4 ±2. 6） d vs. （ 13.7 ± 2. 4） d,P 〈0. 01 ]. Postoperative complications developed in 18 patients in the LAP group and in 30 patients in the OPEN group, the difference was not statistically significant between the two groups. Conclusions In the hands of experienced surgeons laparoscopy-assisted D2 radical total gastrectomy for gastric cancer is safe, effective and miniinvasive.