腹腔镜辅助与开腹远端胃癌D2根治术的治疗效果比较

Comparison of laparoscopic-assisted vs. open radical distal gastrectomy with D2 lymph node dissec-tion for gastric cancer

目的探讨腹腔镜辅助远端胃癌D2根治术的治疗效果。方法分析2008年11月至2011年10月行腹腔镜辅助和开腹远端胃癌D2根治术患者的临床资料，其中腹腔镜组61例，开腹组37例作为对照。结果56例顺利完成腹腔镜手术，5例中转，手术时间：腹腔镜组（178．00±15．51）min，开腹组（147．86±17．41）min；术中出血量：腹腔镜组（138．43±39．67）ml，开腹组（362．86±59．86）ml（P〈0．05）；平均切口长度：腹腔镜组（5．12±0．85）cm，开腹组（18．40±1．98）cm；两组在淋巴结清扫数量上差异无统计学意义（P〉0．05）。开腹组术后发生5例肺部感染，腹腔镜组发生3例肺部感染，差异无统计学意义（P〉0．05）。根据术后病检回报：两组均达到了癌肿的整块切除。规律随访得知所有患者均存活，未发现有远处转移。结论腹腔镜辅助胃癌D2根治手术可以达到根治和微创的双重效果，其远期疗效有待进一步随访观察。

Objective To investigate the curative effectiveness of laparoscopic-assisted radical distal gastrectomy. Methods The clinical data of patients With distal gastric cancer were retrospectively analyzed in our department during November 2008 and October 201i. All patients were subjected to the laparoscopic-assisted （n = 61 ） Or open （n = 37） radical distal gastrectomy with D2 lymph node dissection. Results In laparoscopic-assisted group, 56 cases underwent laparoscopic-assisted surgery successfully and 5 cases were converted to open surgerys. By comparison, the operation time in iaparoscopic-assisted group was longer than in open group [ （ 178.00 ± 15.51 ） min vs. （ 147.86 ± 17.41 ） mini. In laparoscopic-as- sisted group and control group, the blood loss was （ 138.43 ±39.67） and （362. 86±59. 86） ml, incision length was （5.12 ± 0. 85 ） and （18.40 ± 1.98） cm, and postoperative anal exhaust time was （3. 18 ± 0. 86） and （4. 29 ± 1.09） days, respectively （P 〈0. 05）. There was no significant difference in the num- ber of the lymph nodes and the postoperative pulmonary infection between two groups （ P 〉 0. 05 ）. Accord- ing to the postoperative pathologic results, the radical resection was achieved in two group. During the reg- ular follow-up period, all patients were alive and had no distant metastasis. Conclusion Laparoscopic-as- sisted radical gastrectomy with D2 lymphadenectomy can achieve the same cancer clearance as open surger- y. It is safe, feasible and minimally invasive.