全腔镜与腔镜辅助胃癌根治全胃切除术的临床疗效比较

Comparison of Outcomes Between Total Laparoscopic Gastrectomy and Laparoscopy-Assisted Gastrectomy for Gastric Cancer

目的:比较全腔镜胃癌根治术(TLG)与传统腔镜辅助胃癌根治术(LAG)全胃切除的安全性及可行性。方法:回顾性分析2012年1月至2014年3月我院30例TLG和32例LAG患者的临床资料。结果:62例手术均获成功,无1例中转开腹。与传统的LAG组相比,TLG组吻合时间、清扫淋巴结总数均无明显差异。但术中出血量明显减少,切口长度明显减小,下床活动时间、住院时间明显缩短。且术后患者的疼痛评分明显减轻。TLG组均未出现吻合口漏、吻合口狭窄或吻合口出血等吻合口相关并发症。LAG组1例出现吻合口漏,1例出现吻合口狭窄。结论:全腔镜下吻合技术及小切口腔镜辅助吻合技术在腹腔镜胃癌根治术中均安全可行,TLG组与LAG组相比具有创伤小、出血少、恢复快、住院时间短及疼痛感轻等优势,近期效果显著。

Objective： To compare the safety and feasibility between totally laparoscopic gastrectomy （TLG） and conventional laparoscopic-assisted gastreetomy （LAG） in gastric cancer. Methods： Clinical data of 30 patients who received totally laparoscopic gastrectomy and another 32 patients who received conventional laparoscopic-assisted gastrectomy in our hospital from January 2012 to March 2014 were retrospectively analyzed. Results： All procedures were completed successfully. Compared with the patients who underwent LAG, there were no significant difference in mean time of anastomosis, number of dissected lymph nodes in the patients who underwent TLG. However there were marked difference in the mean blood loss, the mean incision length, the mean off-bed time and the hospital stay days in the patients who underwent TLG. Meanwhile we found that postoperative pain scores were significantly lower in the patients who underwent TLG than in the patients who underwent LAG. There developed in TLG. These complications included one patient developed anastomotic leakage and LAG. Conclusion： Both TLG and LAG are safe were no complications related to the anastomosis anastomotic leakage, stenosis and bleeding. But one patients developed anastomotic stenosis in and feasible for gastric cancer. Compared with small incision-assisted anastomosis, totally laparoscopic anastomosis is associated with less inju ry, less blood loss, quicker postoperative recovery, shorter time, less pain and satisfactory short term efficacy.