腹腔镜与开腹进展期胃癌根治术近期疗效比较

Short-term efficacy comparison between laparoscopic and open gastrectomy for advanced gastric cancer

目的比较腹腔镜与开腹进展期胃癌根治术近期疗效。方法 77例进展期胃癌患者根据术式分为腹腔镜组42例和开腹组35例,比较腹腔镜与传统开腹胃癌手术的安全性、可行性及术后近期疗效。结果腹腔镜组手术时间短于开腹组,术中出血量明显少于开腹组,差异均有统计学意义(t分别=2.43、4.83,P均<0.05);腹腔镜组与开腹组在胃切除手术范围、并发症发生率比较,差异无统计学意义(χ2分别=2.39、0.04,P均>0.05);在近期疗效方面,腹腔镜组切口长度、止痛药使用次数、术后首次下床时间、引流时间及住院时间明显优于开腹组(t分别=41.56、9.86、3.41、3.93、4.64,P均<0.05),但腹腔镜组在切缘距离、淋巴结清扫数目、首次肛门排气时间与开腹组比较,差异均无统计学意义(t分别=0.60、1.22、1.41,P均>0.05)。结论腹腔镜应用于进展期胃癌是安全可行的,也能达到开腹手术相同的效果,且近期疗效明显优于开腹手术。

Objective To compare the short-term efficacy between laparoscopic and open gastrectomy for advanced gas-tric cancer. Methods A total of 77 cases of advanced gastric cancer were selected and divided into laparoscopic group（n=42） and open surgery groups（n=35）. The safety, feasibility and short-term efficacy of surgery were compared between two groups. Results The laparoscopic group has significantly shorter surgery time and fewer blood loss compared to open surgery group（t=2.43,4.83,P〈0.05）. There was no statistical difference of surgical excision area and complication rate be-tween two groups（χ2=2.39, 0.04, P〈0.05）. On the short-term efficacy, laparoscopic group has significantly shorter incision, less analgesic medication, shorter postoperative activity out of bed days, shorter drainage time and hospital stay（t=41.56, 9.86, 3.41, 3.93, 4.64, P〈0.05）. However, there was no statistical differences of incisal margins, lymph node elimination number and the time of anal aerofluxus between two groups（t=0.60, 1.22, 1.41, P〈0.05）. Conclusion Laparoscopic gastrectomy is safe and feasible for advanced gastric cancer patients. It achieves the similar effects as open surgery but is better in short-term efficacy.