Ⅱ Ⅲ型食管胃结合部癌腹腔镜根治术与传统根治术疗效的临床比较

Clinical analysis of laparoscopic radical gastrectomy (LRG) and traditional open radical surgery (TORS) in treating Ⅱ Ⅲ type gastroesophageal junction cancer

目的探讨比较Ⅱ、Ⅲ型食管胃结合部癌腹腔镜根治术与传统开腹癌根治术的临床疗效。方法回顾性分析2009年7月至2011年7月行根治性手术的食管胃结合部恶性肿瘤病例200例,患者均为Ⅱ、Ⅲ型食管胃结合部恶性肿瘤。所有病例均随机选择,接受腹腔镜手术组100例,传统手术组100例,比较两组手术一般情况、病理学资料、术后并发症、复发或转移率等方面的差异。所有数据均采用SPSS 13.0软件进行统计分析,计量资料采用t检验,计数资料采用卡方检验,P<0.05表示有统计学意义。结果腔镜组[(220±45)min]手术时间长于传统组[(140±26)min](t=15.382,P<0.001),但术中出血量[(140±89)ml比(220±58)ml],术后腹腔引流总量[(110±83)ml比(223±92)ml]及术后吗啡用量[(12.2±2.6)mg比(21.3±3.2)mg]均明显少于传统组(t=7.525、t=9.120、t=22.087,P<0.001)差异有统计学意义。两组术后住院时间、淋巴结清扫数目、术后并发症发生率、同期复发转移率(t=0.488、χ2=0.038、χ2=0.687、χ2=0.199,P>0.05)差异无统计学意义。结论Ⅱ、Ⅲ型食管胃结合部癌腹腔镜根治术安全、可行与传统开放癌根治术相同的治疗效果。

Objective The aim of this study was to compare the clinical outcome between laparoscopic radical gastreetomy （LRG） with traditional open radical surgery （TORS） in treating Ⅱ Ⅲ type gastroesophageal junction cancer. Methods A retrospective analysis was performed from July 2009 to July 2011. In total, 200 patients with type Ⅱ Ⅲ gastroesophageal junction cancer in our hospital were enrolled, which were divided randomly into LRG group （ 100 cases） and TORS group （ 100 eases）. Clinical data in 2 groups, including general data of operation, pathologic results, postoperative complications, recurrence or metastasis rate were compared. SPSS 13.0 software was employed for the statistical analysis. Measurement data used t test and count data used chi-square test. P 〈 0.05 was considered as statistical significance. Results The average operation time in LRG group [ （ 220 ± 45 ） rain ] was longer than that in TORS group [ （140 ±26）mini, with significant difference （t = 15. 382, P 〈0. 001 ）. However, blood loss （ （ 140 ± 89） ml vs. （220 ± 58 ）ml）, postoperative peritoneal drainage fluid volume [ （110 ± 83 ）ml vs. （223 ± 92 ） ml ] , and postoperative morphine consumption [ （ 12.2 ± 2.6 ） mg vs. （ 21.3 ± 3.2 ） mg ] was less than conventional surgery group （ t = 7. 525, t = 9. 120, t = 22. 087 respectively, P 〈 0. 001 ）. No significant diffrence was observed in the postoperative hospital stay （ t = 0. 488, P 〉 0.05 ）. Number of lymph node dissection （χ^2 = 0. 038, P 〉 0.05 ） and postoperative complications （χ^2 = 0. 687, P 〉 0.05 ） was not significantly different. It was no significant difference in the postoperative recurrence rate over the same period （χ^2 = 0. 199, P 〉 0.05） for the two methods. Conclusion LRG is safe and feasible in treating Ⅱ Ⅲ type gastroesophageal junction cancer, with similar clinical outcome of TORS.