腹腔镜下远端胃癌根治与D2淋巴结清扫安全性及可行性分析

Safety and feasibility of laparoscopic radical distal gastrectomy and D2 lymph node dissection

目的探讨腹腔镜下远端胃癌根治与D2淋巴结清扫的效果及安全性。方法收集80例远端胃癌患者,40例行腹腔镜下远端胃癌根治术的患者为研究组,40例采用开腹手术治疗的患者为对照组,对比分析两组手术指标(切口长度、手术时间、术中出血)、术后恢复情况(排气时间、下床活动时间、镇痛次数、并发症)及肿瘤根治范围等,评价腹腔镜胃癌根治的效果和安全性。结果研究组手术时间显著长于对照组,但切口长度、术中出血量均明显少于对照组,差异有统计学意义(P<0.05)。两组肿瘤近端及远端切缘、淋巴结清扫数量比较,差异无统计学意义(P>0.05)。研究组术后镇痛次数、肛门排气时间、下床活动时间明显少于对照组,差异有统计学意(P<0.05);除肺部感染外,两组其他并发症发生率差异无统计学意义(P>0.05)。结论腹腔镜下远端胃癌根治与D2淋巴结清扫虽然手术时间较长,操作复杂,但能够达到开腹手术相同的胃癌切除标准和淋巴清扫范围,且术后恢复方面有明显优势,值得应用。

Objective To investigate the efficacy and safety of laparoscopic radical distal gastrectomy and D2 lymph node dissection. Methods The clinical data of patients with distal gastric cancer from April 2010 to October 2013 in our hospital were selected,and 40 patients underwent laparoscopic radical distal gastrectomy were randomly selected as the study group,40 cases treated with laparotomy were selected as control group. The surgical indicators( incision length,operative time,blood loss),postoperative recovery( exhaust time,ambulation time,analgesic times,complications) and tumor cure range of the two groups were compared and analyzed,in order to evaluate the efficacy and safety of laparoscopic radical distal gastrectomy. Results The operative time of study group was significantly longer than that of the control group,but the incision length,blood loss were significantly less than those of the control group,and the differences were statistically significant( P < 0. 05). The proximal and distal tumor incisal margins,number of lymph node dissection between the two groups were not significantly different( P > 0. 05). Postoperative analgesic times,exhaust time,ambulation time were significantly less than those of the control group,and the difference was statistically significant( P < 0. 05). In addition to lung infection,other complication rate of the two groups was no significantly different( P > 0. 05) Conclusion Although laparoscopic radical distal gastrectomy and D2 lymph node dissection cost more time,and operation is complex,but it can achieve the same gastric resection standard and lymph node dissection with open surgery,and has obvious advantages in postoperative recovery,so it is worth clinical application.