两种D2淋巴结清扫术式用于进展期胃癌患者临床对比研究

Comparative study of two kinds of D2 lymphadenectomy in the treatment of patients with advanced gastric cancer

目的：比较开腹和腹腔镜D2淋巴结清扫术式用于进展期胃癌患者的临床疗效。方法研究对象选取近年来收治的进展期胃癌患者共90例，采用随机数字表法分为A组（45例）和B组（45例），分别采用开腹和腹腔镜D2淋巴结清扫术式治疗；比较两组患者围手术期临床指标、淋巴结清扫数目，随访1年生存率及术后并发症发生率等。结果 B组围手术期临床指标均显著优于A组，差异均有统计学意义（t＝2.13、2．56、1．98、1．96、1．94、2．05、2．10，均P＜0．05）；B组第二站淋巴结清扫数目显著少于A组，差异有统计学意义（t＝2．15，P＜0．05）；A组和B组随访1年生存率分别为88．89％、91．11％，两组1年生存率比较差异无统计学意义（χ2＝1．67，P＞0．05）；A组和B组术后并发症发生率分别为20．00％、8．89％，B组术后并发症发生率显著低于A组，差异有统计学意义（χ2＝9．44，P＜0．05）。结论腹腔镜D2淋巴结清扫术式用于进展期胃癌患者可有效减少术中创伤，加快术后康复进程，并有助于降低术后并发症发生风险，效果优于开腹D2淋巴结清扫术式。

Objective To investigate the clinical effects differences of two kinds of D2 lymphadenectomy in the treatment of patients with advanced gastric cancer including open operation and laparoscopy operation.Methods 90 patients with advanced gastric cancer were chosen in recent years in our hospital and were randomly divided into both group including group A （45 patients）with D2 lymphadenectomy by open operation and group B （45 patients） with D2 lymphadenectomy by laparoscopy operation;and the clinical indicators in peri-operation period,the dissec-tion number of lymph node,survival rate in 1 year with follow-up and postoperative complication incidence of both groups were compared.Results The clinical indicators in peri-operation period of group B was significantly better than that of group A （t=2.13,2.56,1.98,1.96,1.94,2.05,2.10,all P〈0.05）.The N2 dissection number of lymph node of group B was significantly fewer than that of group A （t=2.15,P〈0.05）.The survival rate in 1 year with follow-up of group A and group B were separately 88.89%and 91.11%,there was no significant difference in survival rate in 1 year with follow-up between the two groups（χ2 =1.67,P〉0.05）.The postoperative complication incidence of group A and group B were separately 20.00% and 8.89%,the postoperative complication incidence of group B was significantly lower than that of group A （χ2 =9.44,P〈0.05）.Conclusion Compared with D2 lymph-adenectomy by open operation,D2 lymphadenectomy by laparoscopy operation in treatment of patients with advanced gastric cancer can efficiently decrease the degree of surgical trauma,accelerate the process of recovering after opera-tion,and be helpful to reduce the risk of postoperative complications.