腹腔镜辅助与开腹近端胃癌根治术的比较

Comparative study between laparoscopy-assisted radical gastrectomy and open gastrectomy for proximal gastric cancer

目的:探讨腹腔镜辅助近端胃癌根治术的可行性及临床效果。方法:对2010年1月至2012年12月38例行腹腔镜辅助近端胃癌根治术患者(腹腔镜组)临床资料和同期我院行传统开腹近端胃癌根治术患者(开腹组)40例进行回顾性分析,比较两组手术安全性、术后并发症和手术病理情况。结果:腹腔镜组术中出血量、切口长度显著低于开腹组。腹腔镜组手术平均用时与开腹组相比差异无统计学意义([336±26)min vs(322±41)min,P>0.05]。腹腔镜组与开腹组肿瘤近切缘长度相比差异有统计学意义([3.6±0.7)cm vs(5.3±1.1)cm,P<0.05],远切缘相比差异无统计学意义([6.7±1.1)cm vs(6.6±0.6)cm,P>0.05]。腹腔镜组淋巴结清扫数量为(25±7)枚,开腹组为(23±5)枚,两组相比差异无统计学意义。腹腔镜组术后并发症的发生率与开腹组相比差异无统计学意义。结论:腹腔镜辅助近端胃癌根治手术能够达到与开腹手术相当的淋巴结清扫效果,并且手术创伤较小;辅助小切口下,处理近端切缘手术操作较为困难,可能存在切缘相对不足的情况,近端胃癌腹腔镜手术应特别关注近端切缘手术处理。

Objective： To evaluate the feasibility and efficacy of laparoscopy-assisted radical gastrectomy and open gastrectomy for proximal gastric cancer. Methods： From January 2010 to December 2012, 78 patients with proximal gastric cancer were operated, of whom 38 underwent laparoseopy-assisted total gastreetomy（LATG） with D2 dissection of lymph nodes and 40 received conventional open D2 total gastrectomy（OTG）. The safety, complication rate and operative pathologic situabion were compared between the two groups. Results： Compared to OG group, the mean blood loss and length of incision were less. The operation time in LATG and OTG [（336±26） min vs.（322±41） min, P0.05] were not significantly. Between two groups, the mean number of removal LN in LATG and OTG [（25±7） vs.（23±5）, P0.05] were not significantly too. The tumor resection proximal margin length in LATG [（3.6 ± 0.7） cm] was less than that of OTG [（5.3 ± 1.1） cm]. However, the tumor resection distal margin length in LATG and OTG [（6.7±1.1） cm vs.（6.6±0.6） cm] were not significantly（P0.05）. The postoperative morbidity were not significantly in the two groups. Conclusion： Laparoscopy- assisted radical gastrectomy with D2 LN dissection is oncologically compatible with open gastrectomy in proxi- mal gastric cancer, and a less invasive procedure. There is more difficultly in the operation of the tumor resection proximal margin in LATG because of the less assisted incition, being the possibility of shortage for resection margin, we should pay more attention to the proximal margin in LATG.