腹腔镜与开腹近端胃癌根治术对患者疗效比较分析

Laparotomy and laparoscopic radical gastrectomy in treating proximal gastric cancer

目的探讨腹腔镜与开腹近端胃癌根治术对近端胃癌患者疗效。方法将2012年7月至2014年7月收治的80例近端胃癌患者随机分为腹腔镜组40例和开腹组40例,采用SPSS19.0统计学软件进行分析,患者术中、术后指标采用x珋±s表示,用t检验;术后1年生存率、肿瘤复发率比较采用χ2检验;手术前后凝血功能指标、血清肿瘤标志物采用重复测量方差分析,以P<0.05为差异有统计学意义。结果腹腔镜组手术时间显著高于开腹组,术中出血量、排气时间、术后下床时间均显著低于开腹组(P<0.05),两组患者淋巴结清扫数量比较差异无统计学意义(P>0.05)。两组患者术后凝血酶原时间(PT)呈降低趋势,纤维蛋白原(FIB)、D-二聚体(D-D)呈上升趋势,与手术前比较差异具有统计学意义(P<0.05),其中术后腹腔镜组纤维蛋白原、D-二聚体显著高于同时段开腹组,两组间比较差异亦有统计学意义(P<0.05)。腹腔镜组1年生存率97.5%(39/40),开腹组为95.0%(38/40);腹腔镜组1年复发率5.0%(2/40),开腹组7.5%(3/40),两组患者术后1年生存率、肿瘤复发率比较差异均无统计学意义(P>0.05)。结论腹腔镜与开腹近端胃癌根治术近期疗效无明显差异,但是腹腔镜术后血栓形成的风险更高,需要在围手术期采取相应预防措施。

Objective To investigate the outcome of laparotomy and laparoscopic radical gastrectomy in treating proximal gastric cancer. Methods Eighty patients with proximal gastric cancer were randamly divided into a laparoscopic group （40 patients ） and an open group （40）. Clinical data were analyzed using SPSS statistical software. Perioperative measurement data were expressed as mean ± SD and examined using Student＇ s t test. The one-year survival and recurrence rates were compared by the Chi-square test. Preoperative, postoperative coagulation function and serum tumor marks were examined by repeated variance analysis. P 〈 0. 05 was considered statistically significant. Results The operation time in the laparoseopic group was longer than that in the open group, whereas the amount of bleeding, time of exhaust and time ambulation were shorter than those in the open group （P 〈 0.05 ）. There was no significant difference in harvested lymph nodes between the two groups （P 〉 0.05 ）. Compared with preoperative indexes, PT showed a decreasing trend, but D-D and FIB showed a raising trend after surgery in the two groups （ P 〈 0. 05 ）. FIB and D-D in the laparoscopic group were significantly higher than those in the open group （P 〈0.05）. The 1-year survival rates in laparoscopic group and open group were 97.5% （39/40） and 95.0% （38/40） respectively, whereas the recurrence rates were 5.0% （2/40） and 7.5% （3/40） respectively （P 〉 0.05 ）. Conclusion Laparoscopic operation and laparotomy for gastric cancer have similar short-term clinical outcomes; however the risk of thrombosis after laparoscopic operation is higher, thus preventive treatment is required for selective patients perioperatively.