腹腔镜对比开腹行胃癌D2根治术的临床研究

Clinical study of laparoscopy versus open surgery with D2 lymphadenectomy for gastric cancer patients

目的:分析腹腔镜对比传统开腹手术行胃癌D2根治术的疗效。方法:回顾性分析兰州市第二人民医院肿瘤外科2012年2月2012年12月期间完成开腹手术行胃癌D2根治术(开腹手术组36例)和腹腔镜胃肿瘤D2根治术(腹腔镜组35例)患者的临床资料,分析两组患者的手术切口长度,手术时间,手术期间出血量,手术后住院时间、伤口感染和肠梗阻的发生率、手术后止痛药应用次数、排气时间、进流食时间、平均淋巴结清扫数目等。采用SPSS19.0统计软件进行统计分析。结果:腹腔镜组和开腹手术组在手术切口长度、手术时间、手术后止痛药应用情况、排气时间、术后伤口感染发生率和肠梗阻的并发症发生率方面的差异有统计学意义(P<0.05),但在术中出血量、术后住院时间、进流食时间、平均淋巴结清扫数目等方面的差异无统计学意义(P>0.05)。结论:腹腔镜胃肿瘤D2根治术是安全可行的,能达到与开腹手术相同的淋巴结清扫范围,且具有对患者创伤小、手术中出血少、手术后恢复快等优点,在临床值得应用和推广,但远期效果还需要进一步研究。

Objective：To evaluate the effectiveness of laparoscopy versus open surgery with D2 lymphadenectomy for gastric cancer. Methods： From Jan 2012 to Jan 2013, a series of 36 patients were undertook open distal gastrectomy D2 gastrectomy （open group）, 35 patients were undertook laparoscopic assisted D2 gastrectomy （laparoscopic group） in which the related outcome of two groups were compared including length of incision,surgical duration,intraoperative blood loss,the number of wound infection and intestinal obstruction,the situation of postoperative pain,exhaust time,postoperative eating date,numbers of harvested lymph nodes. The data were analyzed by SPSS19.0 software in two groups. Results： There were significant difference between two groups in length of incision,surgical duration,the situation of postoperative pain,exhaust time,and the number of wound infection and intestinal obstruction,but no difference in intraoperative blood loss,hospital stay,postoperative eating date, time of drainage and cost of operation, but no difference in surgical duration,intraoperative blood loss,and numbers of harvested lymph nodes. Conclusion： Laparoscopical D2 lymphadenectomy for gastric cancer is a safe,feasible,effective and minimally invasive technique with short term outcome,but the long term effect of laparoscopy still needs further confirmation.