腹腔镜辅助胃癌D_2根治术的临床研究

Clinical Study of Laparoscopic-assisted D_2 Radical Gastrectomy for Gastric Carcinoma

目的 探讨腹腔镜辅助下胃癌D2根治术治疗胃癌的可行性、安全性和根治性.方法 回顾性分析2011年5月~2012年9月进行的112例胃癌根治术,由患者选择手术方式,腹腔镜组50例,开腹组62例.比较2组手术时间、术中出血量、淋巴结清扫数量、术后肛门排气时间、术后住院时间和术后并发症.结果 腹腔镜组均在腹腔镜辅助下完成根治性胃切除和淋巴结清扫,无中转开腹.腹腔镜组手术时间[（231.8±44.2）min]、清扫淋巴结数[（18.4±5.5）枚]与开腹组[（223.6±36.9）min、（20.5±5.9）枚]比较,差异无显著性（t=1.070,P=0.287;t=-1.930,P=0.056）.腹腔镜组术中出血量[（160.5±136.4）ml]、术后肛门排气时间[（3.0±1.4）d]、术后住院时间[（11.5±2.3）d]均小于开腹组[（231.6±121.7）ml、（4.8±2.3）d、（14.3±3.9）d],差异有显著性（t=-2.912,P=0.004;t=-4.854,P=0.000;t=-4.484,P=0.000）.腹腔镜组术后并发症发生率为12.0%（6/50）,低于开腹组（21.0%,13/62）,但差异无显著性（χ2=1.580,P=0.209）.两组均无围手术期死亡,术后病理分期差异无显著性（χ2=2.064,P=0.356）.结论 熟悉局部解剖与淋巴结清扫技巧,腹腔镜辅助下胃癌D2根治手术是安全可行的,且具有创伤小、并发症少、恢复快等优点.

Objective To evaluate the feasibility, safety and cancer clearance effect of laparoscopic-assisted D2 radical gastrectomy for gastric carcinoma. Methods The clinical data of 112 gastric cancer patients undergoing radical gastrectomy from May 2011 to September 2012 were retrospectively reviewed and analyzed. Based on patients＇ will, they were divided into laparoscopic group （50 cases） and open group （62 cases）. The operative time, intraoperative blood loss, number of lymph nodes dissected, time for the passage of flatus, postoperative hospital stay and postoperative complications between the two groups were compared. Results In the laparoscopic group, all the surgeries were completed successfully without conversion to open surgery. No significant difference was found between the two groups in operative time [ （231.8 ± 44.2） min vs. （223.6 ± 36.9） min, t = 1. 070, P = 0. 287） ] and the number of lymph nodes dissected （18.4 ±5.5 vs. 20.5 ±5.9, t = - 1. 930, P =0.056）. The blood loss was less, the time for the passage of flatus was shorter and postoperative hospital stay was shorter in the laparoscopie group than in the open group with statistical difference[ （160.5 ±136.4） ml vs. （231.6 ±121.7） ml, t = -2.912, P=0.004; （3.0 ±1.4） d vs. （4.8 ±2.3） d, t= -4.854, P=0.000; （11.5 ±2.3） d vs. （14.3 ±3.9） d, t = -4.484, P=0.000]. The postoperative complication rates of the laparoscopic group were lower than that of the open group with no statistical difference [ 12.0% （6/50） vs. 21.0% （ 13/62）, X2 = 1. 580, P = 0. 209 ]. No death occurred during the perioperative period in both groups, and no statistical difference was found in the postoperative pathological stages between the two groups （X2 = 2. 064, P = O. 356）. Conclusions Laparoscopic-assisted O2 radical gastrectomy for gastric carcinoma is feasible and safe if the anatomical structure and the techniques of lymph node dissection were mastered. Laparoscopic-assisted DE radical gastreetomy for gastric carcinoma has the advantages of smaller trauma, fewer complications, and quicker recovery.