摘要
目的探讨腹腔镜胃癌D:淋巴结清扫术在治疗进展期胃癌中的临床价值。方法回顾性分析2004年1月至2011年6月手术治疗的239例进展期胃癌,根据患者接受的手术方式不同分为腹腔镜组102例、开腹组137例。结果腹腔镜组的切口长度、术中出血量、胃肠功能恢复时间、进食时间、术后住院天数分别为(5.0±1.1)Cnl、(70±44)ml、(57±14)h、(68±13)h、(7.1±1.4)d,开腹组分别为(17.4±2.1)tin、(107±59)ml、(75±12)h、(91±15)h、(9.9±1.8)d,两组比较差异均有统计学意义(t=-58.86、-5.50、-10.72、-12.58、-12.58,均P=0.00)。腹腔镜组手术时间为(192±32)min,开腹组为(185±30)rain,两组比较差异无统计学意义(t=1.63,P=0.11)。腹腔镜组平均近、远端切缘、淋巴结清扫数目分别(5.0±1.0)CIH、(4.7±0.8)cm、(27.6±7.2)枚,开腹组分别为(5.1±0.9)cm、(4.7±0.9)cm、(27.0±6.5)枚,两组比较差异均无统计学意义(t=-0.61、0.10、0.68,均P〉0.05)。腹腔镜组术后第3、5、7天外周血白细胞计数分别为(11.1±1.3)×10。/L、(9.5±1.4)×10^9/L、(7.0±1.5)×10。/L,开腹组分另0为(12.8±1.3)×10^9/L、(11.1±1.5)×10^9/L、(8.6±1.3)×10^9/L,两组比较差异均有统计学意义(t=9.83、8.88、-9.40,均P=0.00)。腹腔镜组并发症发生率为9.8%(10/102)、开腹组为17.5%(24/137),两组比较差异无统计学意义(x2=0.285,P=0.09)。腹腔镜组平均治疗费用为(2.4±0.4)万元,开腹组为(2.3±0.3)万元,两组比较差异无统计学意义(t=1.87,P=0.06)。腹腔镜组术后1、3、5年生存率分别为96.1%、74.1%、47.2%,开腹组分别为95.6%、70.0%、50.9%,两组比较差异均无统计学意义(x。=0、0.04、0.21,均P〉0.05);腹腔镜组1、3、5年无瘤生存率分别为88.2%、55.2%、36.1%,开腹组分别为84.7%、51.3%、27.5%,两组比较差异均无统计学意义(x2=0.62、0.06、0.37,均P〉0.05)。结论在经过选择的患者中,腹腔镜胃癌D:淋巴结清扫术治疗进展期胃癌是有效、安全、可行的,其近期疗效优于开腹手术,而中、远期疗效则与开腹手术相当。
Objective To evaluate laparoscopic D2 lymph node dissection gastrectomy in the treatment of advanced gastric cancer. Methods The clinical data of 239 cases of advanced gastric cancer admitted from January 2004 to June 2011 were respectively analyzed, patients were divided into laparoscopie resection group and open surgery group. Data analysis was performed by SPSS 19.0 statistical software. Results There were 102 cases in laparoscopie group, and 137 cases in open group. The length of incision, operative blood loss, recovery time of gastrointestinal function, food-taking time and postoperative hospital stay inlaparoscopic operation group were (5.0 ±1.1) cm, (70±4) ml, (57 ±14) h, (68 ±2) h, (7.1 ± 1.4) d and in open operation group were ( 17.4 ±2. 1 ) cm, ( 107 ±59) ml, (75 ±12) h, (91 ± 15 ) h, (9. 9 ± 1.8 ) d respectively. There were significant differences between the two groups (t = -58.86, -5.50, - 10. 72, - 12.58, - 12. 58,all P =0. 00). There was no significant differences between the two groups in operative time ( t = 1.63, P = O. 11 ) , with operative time in laparoscopie operation group of (192 ± 32) rain, and (185 ± 30) rain in open group. Average proximal, distal cutting edge and the averagenumber of lymph node harvested were ( 5.0 ± 1.0) cm, (4. 7 ~ 0. 8 ) cm, ( 27.6 ~ 7.2 ) in laparoscopic operation group, and (5. I ±-0. 9) cm, (4.7 _±0. 9) cm, (27.0 ±6. 5) in open group (t = -0. 61,0. 10, O. 68, P 〉 0. 05 ). The 3-, 5-, 7 d white blood cell counts in laparoscopic group was ( 11.1 ± 1.3 ) x 109/L, (9.5 ±1.4) ~ 109/L, (7.0 ±1.5 ) x 109/L, and ( 12. 8 ±1.3) 109/L, ( 11.1 ±1.5 ) 109/L, (8.6 ±- 1.3 ) ~ 109/L, in open group ( t = - 9. 83, - 8. 88, - 9.40, all P = 0.00). Complications developed in 9.8% (10/102)in laparoscopic operation group, and 17.5% (24/137)in open group (X2 = 0. 285, P =0. 09). The 1-year, 3-year, 5-year survival rate of patients in laparoscopic group were 96. 1% , 74. 1%,47.2%, and 95.6%, 70. 0%, 50. 9% in open group (X2=0, 0.04, 0.21, P 〉0.05). Conclusions In selected cases, laparoscopic D2 lymph node dissection gastrectomy for advanced gastric cancer is safe and effective, and long-term outcomes are satisfactory.
出处
《中华普通外科杂志》
CSCD
北大核心
2013年第6期413-416,共4页
Chinese Journal of General Surgery
关键词
胃肿瘤
腹腔镜
胃切除术
淋巴结切除术
Stomach neoplasms
Laparoscopes
Gastrectomy
Lymph node exicision