腹腔镜与开腹手术行胃癌根治术效果的临床对照研究

Comparative Study of Laparoscopic and Open Radical Surgery in Gastric Carcinoma

目的探讨应用腹腔镜行胃癌根治术的效果及安全性。方法回顾性分析2009年1月—2010年6月在我院行根治性手术的101例胃癌患者的临床资料,其中腹腔镜手术51例(腹腔镜组),开腹手术50例(开腹组)。观察两组手术切口长度、手术时间、术中失血量、淋巴结清扫个数、术后排便时间、术后住院时间、围术期并发症发生情况。每月随访1次,随访终点为2010-12-31,记录患者失访、复发、转移及死亡情况。结果腹腔镜组与开腹组患者手术切口长度、手术时间、术中失血量、术后排便时间、术后住院时间比较,差异均有统计学意义(P<0.05);两组患者淋巴结清扫个数比较,差异无统计学意义(P>0.05)。开腹组术后无并发症发生,腹腔镜组2例出现并发症,1例为术后残胃功能障碍,1例为腹腔感染。腹腔镜组平均随访时间为(14.3±9.0)个月,失访3例,失访率为6%;开腹组平均随访时间为(15.8±10.3)个月,失访6例,失访率为12%。两组随访时间、失访率比较,差异均无统计学意义(P>0.05)。腹腔镜组复发率为4%(2/48)、转移率为4%(2/48)、病死率为6%(3/48),开腹组分别为4%(2/44)、4%(2/44)、9%(4/44),两组比较差异均无统计学意义(P>0.05)。结论经腹腔镜行胃癌根治术与开腹手术相比具有创伤小、失血量少、术后恢复快等优点,且根治度与开腹手术无明显差别,短时期复发、转移及病死率无明显增加,值得推广。

Objective To investigate the effect and safety of laparoscopic and open radical surgery in patients with gas- trie carcinoma by retrospective study. Methods Clinical data of 101 patients with gastric carcinoma underwent radical surgery in our hospital from January 2009 to June 2010 were retrospectively analyzed. Among the patients, 51 cases were given laparoscopic surgery （laparoscopic group） and 50 eases were given open surgery （open surgery group）. The length of incision, operation time, blood loss, lymph node dissection number, defecating time after operation, hospital stay after operation and complications during perioperative period were observed. The patients were followed up one time a month until December 31, 2010. The loss of following up, relapse, metastasis and death were recorded. Results The length of incision, operation time, blood loss, defecating time and hospital stay after operation between laparoscopic group and open surgery group showed statistically significant differences （ P 〈 0. 05 ）. While the difference of lymph node dissection number between the two groups was not statistically significant （ P 〉 0.05 ）. No complication was found in the open surgery group after surgery, while 2 cases had complication in laparo- scopic group, with one case having dysfunction of residual stomach and one case having abdominal infection. The average following up time of the laparoscopic group was （ 14. 3 ± 9.0） months, with 3 cases being lost and loss rate of 6% ; the average follow- ing up time of the open surgery group was （ 15.8 ± 10. 3 ） months, with 6 cases being lost and loss rate of 12%. The following up time and loss rate between the two groups showed no statistically significant differences （ P 〉 0. 05 ）. The relapse rate, metastasis rate and mortality rate of laparoscopic group were 4% （2/48）, 4% （2/48） and 6% （3/48）, and they were 4% （2/44）, 4% （2/44） and 9% （4/44） for the open surgery group. The difference between the two groups was not statistically significant （P 〉 0. 05 ）. Conclusion Compared with open radical surgery, laparoscopic surgery has advantages like fewer traumas, less blood loss and rapid recovery, etc, and there is no significant difference on radical degree between the two groups. Besides, the recurrence, metastasis and mortality showed no increase compared with open surgery, so it is worth promoting in clinic.