完全3D腹腔镜与开腹胃底贲门癌根治术的对比研究

Comparison between completely 3D laparoscopic resection of the gastric cardia carcinoma and open radical resection

目的:比较完全3D腹腔镜胃底贲门癌根治术(completely 3D laparoscopic radical resection of the gastric cardia carcinoma,C3DLRRGCC)与开放手术(radical resection of the gastric cardia carcinoma,RRGCC)的优势与不足,探讨完全腹腔镜胃底贲门癌根治术的可行性。方法:选取2012年1月至2014年12月行C3DLRRGCC的96例患者,其中76例行根治性全胃切除术,20例行根治性近端胃切除术,并与108例RRGCC的患者进行回顾性分析,比较其可行性。结果:96例C3DLRRGCC病例均行标准D2淋巴结清扫术。全胃切除术时,开腹组手术时间优于腹腔镜组(P<0.05),腹腔镜组术中出血量、清扫淋巴结数量、术后胃肠道恢复时间、术后切口感染例数、随访期内肠梗阻例数优于开腹组(P<0.05),两组患者术后出血例数、吻合口漏发生率差异无统计学意义(P>0.05)。近端胃切除时,腹腔镜组术中出血量、胃肠道恢复时间优于开腹组(P<0.05)。两组均无术后住院期间死亡病例。结论:C3DLRRGCC是安全、可行的,能达到开腹手术的临床效果与清扫目的。

Objective： The aim of the study was comparing the advantage and disadvantage between completely 3D laparoscopic radical resection of the gastric cardia carcinoma（ C3DLRRGCC） and radical resection of the gastric cardia carcinoma（ RRGCC） and explore the feasibility of C3 DLRRGCC. Methods： The clinical data of 96 patients who underwent laparoscopic esophagogastrectomy（ n= 20） and total gastrectomy（ n = 76） for gastric cardia carcinoma and 108 patients who underwent open gastrectomy from Jan. 2012 to Dec. 2014 at General Surgery of Weifang People＇s Hospital were retrospectively reviewed and analyzed to find out the feasibility of C3 DLRRGCC. Results： Ninety-six cases of C3 DLRRGCC were all performed by the standard of D2 lymphadenectomy. There was no conversion to laparotomy from the laparoscopic operation. In the total gastrectomy,the operating time of the laparoscopic group was more than that of the laparotomy group（ P 0. 05）,intraoperative blood loss,the number of lymph nodes harvested,the average time for the gastrointestinal function recovery,the number of incision infection,the number of postoperative ileus of laparoscopic group were better than those of laparotomy group（ P 0. 05）,the number of hemorrhage and anastomotic leakage were not statistically different between the two groups（ P 0. 05）. In the proximal gastrectomy,the intraoperative blood loss and the recovery time of the gastrointestinal function in the laparoscopic group were better than those in the laparotomy group（ P 0. 05）. No patients died during the hospitalization.Conclusions： C3 DLRRGCC is feasible and safe,can reach the same effect as RRGCC and does not increase the recurrence rate.