腹腔镜辅助与开腹远端胃癌根治术治疗进展期胃癌的疗效比较

Comparison of Laparoscopic-Assisted and Open Radical Distal Gastrectomy for Advanced Gastric Cancer

目的比较腹腔镜辅助远端胃癌根治术与开腹远端胃癌根治术治疗进展期胃癌的疗效比较。方法收集76例由同一组医师连续实施远端胃癌根治术的进展期胃癌患者的临床资料。其中行腹腔镜辅助远端胃癌根治术46例（腹腔镜组）,行开腹远端胃癌根治术30例（开腹组）。对2组患者的手术时间、术中出血量、术后通气时间、术后住院时间、住院费用、清扫淋巴结数目、术后并发症（伤口感染、粘连性肠梗阻、胃瘫、吻合口漏等）的发生情况及近期疗效（1、3年的生存率和无瘤生存率）进行比较。结果腹腔镜组的手术时间、住院费用、清扫淋巴结数目、术中出血量及术后并发症例数与开腹组比较差异均无统计学意义（均P〉0.05）。腹腔镜组术后通气时间及术后住院时间均明显短于开腹组（均P〈0.05）。2组患者术中均未发生损伤大血管或周围脏器等严重并发症,腹腔镜组无转开腹病例。2组患者均随访10~52（26.8±9.8）个月,1、3年生存率和无瘤生存率比较差异均无统计学意义（均P〉0.05）。结论对于进展期胃癌患者,腹腔镜辅助远端胃癌根治术是一种可行而短期疗效好的手术方式,远期疗效仍需长期随访。

Objective Comparison of laparoscopic-assisted and open radical distal gastrectomy for advanced gastric cancer.Methods Clinical data of 76 patients with advanced gastric cancer who were treated with radical distal gastrectomy by the same group of doctors were collected.Among the 76 patients,46underwent laparoscopic-assisted radical distal gastrectomy（laparoscopic group）and 30 underwent open radical distal gastretctomy（open group）.The operation time,intraoperative blood loss,time to first postoperative flatus,hospital stay,hospitalization costs,number of lymph nodes harvested,postoperative complications（wound infection,adhesive intestinal obstruction,gastroplegia,anastomotic leakage,etc.）and short-term effects（1-year and 3-year survival rates and disease-free survival rate）were compared between the two groups.Results There were no significant differences in operation time,intraoperative blood loss,hospitalization costs,number of lymph nodes harvested and incidence of postoperative complications between the two groups（P〉0.05）.Compared with open group,the time to first postoperative flatus and length of hospital stay were obviously shortened in laparoscopic group（P〈0.05）.No large blood vessel or surrounding organ damage and other serious complications were observed in both groups.No patients were converted to open surgery in laparoscopic group.All patients were followed up for an average of（26.8±9.8）months（range 10 to 52 months）,and no significant differences in the 1-year and 3-year survival rates and disease-free survival rate were found between the two groups（P〉0.05）.Conclusion Laparoscopic-assisted radical distal gastrectomy is feasible and produces good short-term efficacy in patients with advanced gastric cancer.However,the long-term efficacy needs to be further confirmed.