进展期远端胃癌行腹腔镜与开腹D2根治术的近期疗效对比

Comparison of laparoscopic or open D2 radical gastrectomy for advanced distal gastric cancer

目的 通过对腹腔镜下行进展期远端胃癌D2根治术与开腹胃癌切除手术的比较分析,以评价其有效性和可行性.方法回顾性分析2010年3月至2013年5月手术治疗的184例进展期远端胃癌的临床资料.上述病例根据手术方式分为腹腔镜组82例,开腹组102例.比较两组的淋巴结清扫数目及手术时间、术中失血量、术后恢复、手术并发症等指标.结果 腹腔镜组与开腹组在清扫淋巴结数目（25.3±9.9）个和（20.9±10.0）个上比较,P=0.526,与平均手术时间（231.7±61.1） min和（226.1±47.3） min上比较,差异均无统计学意义（P=0.132）.比较平均失血量（84.7±65.4）ml和（262.3±251.4）ml,P＜0.001;肠功能恢复时间（3.4±1.3）d和 （5.2±1.1）d,两者差异有统计学意义（P＜0.001）,腹腔镜组失血少,肠道功能恢复快.两组病例术后并发症均较少,无统计学意义.结论 腹腔镜进展期远端胃癌D2根治术具有失血少、术后恢复快等微创优势,技术上是安全可行的,清扫淋巴结数目和开腹手术相当,符合肿瘤根治原则,近期疗效肯定.

Objective To compare the feasibility and clinical efficacy of laparascopic D2 radical gastrectomy with conventional open radical resection for treatment of advanced distal gastric cancer. Methods The clinical data of 184 cases of advanced distal gastric cancer, who received treatment in our hospital from March 2010 to May 2013, were analyzed retrospectively. Of these cases, 82 cases were in laparoscopic group and 102 in open group. The lymph node dissection amount, operation time, blood loss, and postoperative recovery and complications of two groups were analysed. Results No significant difference was found in the amount of resected lymph nodes （25.3 ± 9. 9 vs. 20. 9 ± 10. 0, P = 0. 526） and the average operation time （231.7 ± 61.1 min vs. 226. 1 ± 47. 3 rain, P = 0. 132） between two groups. The mean volume of blood loss in laparoscopy group and open group was 84. 7 ± 65. 4 mL and 262. 3 ± 251.4 mL respectively （P〈0. 001）. The time of return to bowel function in laparoscopic group was shorter than in open group. There were little postoperative complications in both two groups. Conclusion The laparoscopic radical resection of gastric carcinoma with D2 lymph node dissection for advanced distal gastric cancer is feasible and safe. There is no difference in amount of re- sected lymph nodes between laparoscopic and open gastrectomy and the laparoscopic gastrectomy can satisfy oncologic criteria. Laparoscopic radical gastrectomy has the advantage of less blood loss, and the faster postoperative recovery than the open surgery. The short-term outcome has been confirmed.