腹腔镜下全胃切除与开腹全胃切除分别联合D2淋巴结清扫治疗进展期胃癌的临床疗效比较

Comparisons of clinical efficacy in short-term and long-term time between laparoscopic total gastrectomy combined with D2 lymph node dissection and open total gastrectomy combined with D2 lymph node dissection for patients with advanced gastric carcinoma

目的比较腹腔镜下全胃切除术与开腹全胃切除术分别联合D2淋巴结清扫治疗进展期胃癌的临床疗效。方法回顾性分析我院普外科228例行根治性全胃切除术联合D2淋巴结清扫治疗的进展期胃癌患者的临床病历资料,观察组行腹腔镜下全胃切除术联合D2淋巴结清扫术,对照组行开腹全胃切除术联合D2淋巴结清扫术,比较两组患者的近远期临床疗效。结果观察组手术时间显著长于对照组（P〈0.001）,而术中出血量明显少于对照组（P=0.004）,两组术中淋巴结检出数目无显著差异（P〉0.05）。观察组首次排气时间、胃肠道功能恢复时间及住院时间显著短于对照组（P均〈0.05）;两组肿瘤近远端切缘长度、住院费用比较,差异无统计学意义（P〉0.05）。观察组术后并发症发生率7.89%,低于对照组的18.42%（P〈0.05）。两组患者平均随访时间2.86±1.61年,两组患者1、3、5年无瘤生存率无显著性差异（P〉0.05）,观察组中位生存时间3.035（95%CI：2.683~3.386）年,对照组中位生存时间2.856（95%CI：2.669~3.044）年,两组患者总体生存时间无显著性差异（P〉0.05）。结论腹腔镜下全胃切除联合D2淋巴结清扫术治疗进展期胃癌相比开腹全胃切除联合D2淋巴结清扫术而言,具有术后恢复快、并发症少、预后较好等优点,且术后远期生存率较高。

Objective To compare the clinical efficacy in short-term and long-term time of laparoscopic total gastrectomy vs..open total gastrectomy combined with D2 lymph node dissection respectively in the treatment of patients with advanced gastric carcinoma. Methods Clinical data of228 patients with advanced gastric carcinoma in our hospital treated by radical total gastrectomy combined with D2 lymph node dissection were retrospectively analyzed, in which observation group underwent laparoscopic total gastrectomy combined with D2 lymph node dissection and control group underwent open total gastrectomy combined with D2 lymph node dissection. Comparisons of clinical efficacy in short-term and long-term time between two groups were conducted. Results The operative time in observation group was significantly longer than that in control group（P〈0.05）, and the intraoperative blood loss was less than that in control group（P〈0.05）. No statistical significance in the number of lymph nodes between groups was found. The first exhaust time, recovery time of gastrointestinal function and hospitalization time in observation group were shorter than those in control group, and the differences were statistically significant（all P values were less than 0.05）. There was no statistical significance on difference of tumor proximal margin and hospitalization cost between two groups. The postoperative complication rate in observation group was lower than that in control group（7.89% vs. 18.42%, P〈0.05）. The average follow-up time was 2.86 ±1.81 years. The survival rate for 1 years, 3 years, 5 years without tumor between two groups was no statistical significance. The median survival time in observation group was 3.035（95%CI ： 2.683-3.386） years, and 2.856（95%CI ： 2.669-3.044） years in control group and there was no statistically significant（P〉0.05）.Conclusion Compared with open total gastrectomy combined with D2 lymph node dissection,laparoscopic total gastrectomy combined with D2 lymph node dissection for patients with advanced gastric carcinoma has characteristics of good short-term clinical efficacy, high safety, and high long-term survival rate.