腹腔镜辅助与开腹远端胃癌D2根治术的疗效分析

ANALYSIS OF CURATIVE EFFECT OF LAPAROSCOPICALLY ASSISTED AND OPEN RADICAL GASTRECTOMY IN GASTRIC CANCER D2 OPERATION

目的对比腹腔镜辅助与开腹远端胃癌D2根治术的临床疗效和安全性,为临床策略的制定提供参考。方法选取在我院胃肠外科行远端胃癌D2根治术的患者58例,随机分为腹腔镜组和开腹组各29例。腹腔镜组的患者采用腹腔镜辅助远端胃癌D2根治术进行治疗,开腹组患者采用开腹远端胃癌D2根治术进行治疗,对比两组患者手术相关指标以及术后病理检查结果。结果腹腔镜组患者术口长度、手术出血量、术后平均注射止痛药物次数、首次肛门排气时间、术后开始下床活动时间以及住院天数均显著少于开腹组,(p<0.05);腹腔镜组患者的手术时间则显著长于开腹组,(p<0.05)。两组患者在清扫淋巴结数量、肿瘤上切缘长度以及肿瘤下切缘长度上的对比,其差异均没有统计学意义,(p>0.05)。腹腔镜组术后并发症发生率为10.34%,开腹组术后并发症发生率为20.69%,腹腔镜组患者术后并发症的发生率显著低于开腹组,(p<0.05)。结论腹腔镜辅助远端胃癌D2根治术具有手术创伤小,术后恢复快,病灶清除彻底,安全性高等优点,值得在临床上进一步推广应用。

Objective To compare the clinical efficacy and safety of laparoscopic and open radical resection in distal D2, and to provide the reference for clinical strategies. Methods 58 patients with gastric cancer underwent gastrointestinal surgical radical resection of distal D2, were selected in our hospital, they were randomly divided into laparoscopic group and laparotomy group with 29 patients in each group. Patients in laparoscopic group used laparoscopic assisted distal gastric cancer radical surgery for D2 treatment, while in the open group were treated with open distal D2 radical gastrectomy, indexes including operation and postoperative pathological examination results of both groups were compared. Results In laparoscopic group the incision length, amount of bleeding, the average postoperative injection of analgesic drugs, the first anal exhaust time, postoperative ambulation and length of hospital stay were significantly less than that of the open group（p 〈 0. 05 ） ; the operation time of laparoscopic group was significantly longer than that of the open group. The patients in both groups with lymph node dissection, tumor number and tumor margin length cutting edge length being compared, the differences were not statistically significant. The complication rate was 10.34% in laparoscopic group; while it was 20.69% in the open group, the incidence of postoperative complications in the lapamscopic group was significantly lower than that of the open group. Conclusion The operation of laparoscopically assisted gastrectomy distal D2 has the advantages of small operation wound, faster postoperative recovery, debridement thoroughly, and high security, so it is worthy of further application in clinical practice.