腹腔镜手术不同术式治疗胃癌210例疗效分析

Laparoscopy-assisted radical gastrectomy with different surgical procedures for gastric cancer:A therapeutic effect analysis of 210 patients

目的探讨腹腔镜手术不同术式治疗胃癌病人的安全性和远期疗效。方法采用回顾性队列研究方法，收集2009年5月至2012年12月北京大学肿瘤医院胃肠肿瘤微创外科行腹腔镜辅助胃癌根治术的210例病人的临床资料，比较不同术式病人的手术相关指标、术后恢复情况和远期疗效。结果行腹腔镜辅助远端胃大部切除术（LADG）100例、近端胃大部切除术（LAPG）35例、全胃切除（LATG）75例。3组间比较，LADG组手术时间最短，术中出血量最少，而LATG组手术时间最长，清扫淋巴结数最多。各组病人在术中输血率、中转开腹率、术后排气时间和术后住院时间方面差异均无统计学意义（均P〉0．05）。在术后并发症方面，各组病人在总体并发症、手术相关并发症和系统并发症发生率方面差异无统计学意义（均P〉0．05）。进一步分层分析显示，LADG组轻微并发症发生率更高，而LAPG和LATG组严重并发症发生率更高（均P〈0．05）。与LADG组相比，LATG组术后再次手术率更高，差异有统计学意义（P〈0．05）。LADG、LAPG和LATG组术后30d内病死率分别为0、0和2．7％，差异无统计学意义（P〉0．05）。随访43（1-80）个月，LADG、LAPG和LATG组病人术后3年总存活率分别为83．6％、67．9％和69．7％，三者比较，差异有统计学意义（χ2=11．119，P〈0．05）。仅以Ⅲ期病人行分层分析显示，LADG、LAPG和LATG组术后3年总存活率分别为67．8％、57．0％和56．1％，三者比较，差异无统计学意义（χ2=1．893，P〉0．05）。结论腹腔镜胃癌手术不同术式在手术时间、术中出血量、清扫淋巴结数和术后并发症构成方面存在差异，但术后排气时间和住院时间基本相当，LADG和LATG远期疗效与国内外文献报道相似。

Objective To investigate the safety and long-term outcomes of laparoscopy-assisted radical gastrectomy with different surgical procedures for gastric cancer. Methods The clinical data of 210 patients with gastric cancer performed laparoscopy-assisted radical gastrectomy with different surgical procedures between May 2009 and December 2012 in DepartmentⅣ of Gastrointestinal Surgery, Peking University Cancer Hospital were analyzed retrospectively. The patients were divided into three groups according to surgical procedures. The operative procedure, postoperative recovery and long-term outcomes were compared among the three groups. Results Of the 210 patients, 100 patients underwent LADG, 35 patients underwent LAPG and 75 patients underwent LATG. Among the three groups, the operation time was the shortest and the volume of intraoperative bleeding was the lowest in LADG group. On the contrary, theoperation time was the longest and the number of lymph nodes harvested was the largest in LATG group （P〈0.05）. No significant difference was observed in terms of blood transfusion rate, conversion to laparotomy, time to first flatus and postoperative hospital stays among the three groups （P〉0.05）. There was no significant difference among the three groups with respect topostoperative complications, surgery-related complications and medical complications （P 〉 0.05）. However, in subgroup analysis, the minor surgery-related complications were more often in LADG group while the major surgery-related complications were more often in LAPG and LATG groups （P 〈 0.05）. Furthermore, the reoperation rate was higher in LATG group when compared with LADG group （P 〈 0.05）. The postoperative 30-day mortalities were 0,0 and 2.7% in LADG, LAPG and LATG group respectively, which showed no significant difference （P〉 0.05）. The median follow-up was 43 months. The 3-year overall survival rates were 83：6%, 67.9% and 69.7% in LADG, LAPG and LATG group respectively, with a significant difference （χ 2=11.119, P〈0.05）. But if patients were limited in stage III disease, the 3-year overall survival rates were 67.8%, 57.0% and 56.1% in LADG, LAPG and LATG group respectively, and there was no significant difference （χ 2=1.893, P〉0.05）. Conclusion There were some differences among different laparoscopic procedures for gastric cancer as referred to operation time, volume of intraoperative bleeding, number of lymph nodes harvested and distribution of postoperative complications. However, the time to first flatus and postoperative hospital stays are similar in LADG, LAPG and LATG group. The long-term outcomes of LADG and LATG were comparable to previous literatures.