腹腔镜辅助与开腹胃癌根治术的短期临床效果比较

Comparison of short-term clinical efficacy of laparoscopy versus laparotomy surgery for patients with gastric cancer

目的比较腹腔镜辅助胃癌根治术与开腹胃癌根治术的短期临床效果。方法选取2014年1—12月于本院普通外科住院并诊断为胃癌的患者185例,男105例,女80例,年龄31～85（55±6）岁,其中腹腔镜辅助胃癌根治术86例（腹腔镜组）,开腹胃癌根治术99例（开腹组）,两组资料具有可比性（P〉0.05）;比较两组短期临床效果。结果与开腹组相比,腔镜组手术切口直径短[（5.8±0.5）cm vs（14.1±1.3）cm,P〈0.05],手术时间长[（190.9±50.3）min vs（150.7±43.1）min,P〈0.05],术中出血量少[（107.3±70.3）ml vs（158.3±90.8）ml,P〈0.05],术后排气时间短[（3.0±0.4）d vs（3.9±0.5）d,P〈0.05],进食时间早[（3.7±0.9）d vs（4.3±0.7）d,P〈0.05],住院时间短[（9.6±3.4）d vs（12.2±6.9）d,P〈0.05],差异均有统计学意义（P〈0.05）。两组的手术切除淋巴结数目[（26.4±7.5）vs（27.2±7.7）,P〉0.05]、淋巴结阳性数[（3.0±1.0）vs（3.0±0.9）,P〉0.05）]、切缘阳性率（1.16%vs 1.01%）和术后并发症发生率（4.6%vs 5.0%）差异均无统计学意义（P〉0.05）。结论传统开腹胃癌根治手术能够彻底切除病灶,但切口大、手术出血量大,术后恢复慢。而腹腔镜辅助胃癌根治术手术创伤小,术后患者恢复快,可获得较好短期临床效果,优势明显,但手术时间稍长。

Objective To explore the short-term clinical effecacy between laparoscopic assisted radical gastrectomy and open radical gastrectomy. Methods One hundred and eighty-five patients who were diagnosed with gastric cancer in our hospital from January to December in 2014 were enrolled in our study. There were 105 males and 80 females with average age of（55±6） years（ranging from 31 to 85 years）. Of the 185 cases, 86 cases had undergone laparoscopic-assisted gastrectomy（laparoscopic group）, and 99 cases with open radical gastrectomy（open group）. The short-term clinical effecacy in these two groups was compared. Results There were significant differences in incision length [（5.8±0.5） cm vs（14.1±1.3） cm, P〈0.05], suigical time [（190.9±50.3） min vs（150.7±43.1） min, P〉0.05], intraoperative blood loss [（107.3±70.3） ml vs（158.3±90.8） ml, P〉0.05], postoperative flatus time [（3.0±0.4） d vs（3.9±0.5） d, P〉0.05], feeding time [（3.7±0.9） d vs（4.3±0.7） d, P 〉0.05] and hospital stay [（9.6±3.4） d vs（12.2±6.9） d, P〉0.05] between two groups. However, there were no significant differences in the number of resected lymph nodes [（26.4±7.5） vs（27.2±7.7）, P 〉0.05], number of positive lymph nodes [（3.0±1.0） vs（3.0±0.9）, P 0.05], positive margin rate（1.16% vs 1.01%, P 〉0.05） and the incidence of postoperative complications（4.6% vs 5.0%, P〉0.05） between two groups. Conclusion Traditional open radical gastrectomy surgery can remove the lesion completely, but it has larger incision, larger amount of bleeding and longer postoperative recovery time. Laparoscopy assisted radical gastrectomy with smaller surgical trauma, faster recovery can achieve better short-term clinical results with a clear advantage, but its surgical time is longer than traditional open radical gastrectomy surgery.