腹腔镜胃癌根治术与开腹胃癌根治术治疗老年胃癌疗效比较

Comparison of the effect between laparoscopic radical gastrectomy and open radical gastrectomy in elderly patients with gastric cancer

目的比较腹腔镜胃癌根治术与开腹胃癌根治术治疗老年胃癌的临床疗效。方法选择2005年3月至2008年3月无锡市第四人民医院收治的老年胃癌患者77例,根据手术方法分为腹腔镜胃癌根治术组(腹腔镜组)36例和开腹胃癌根治术组(开腹组)41例,比较2组患者手术情况、术后恢复情况及术后并发症发生率。随访8 a,比较2组患者复发率和病死率。结果腹腔镜组患者手术时间长于开腹组(P<0.05),术中出血量少于开腹组(P<0.05),切口长度短于开腹组(P<0.05)。腹腔镜组患者肛门排气时间、住院时间显著短于开腹组(P<0.05),镇痛药使用次数显著少于开腹组(P<0.05)。开腹组和腹腔镜组患者并发症发生率分别为22.0%(9/41)和5.6%(2/36),腹腔镜组患者并发症发生率显著低于开腹组(P<0.05)。开腹组患者4 a复发率和病死率分别为12.2%(5/41)和9.8%(3/41),腹腔镜组患者4 a复发率和病死率分别为8.3%(3/36)和2.8%(1/36),2组患者4 a复发率及病死率比较差异无统计学意义(P>0.05)。开腹组患者8 a复发率和病死率分别为34.1%(14/41)和22.0%(9/41),腹腔镜组患者8 a复发率和病死率分别为13.9%(5/36)和5.6%(2/36),腹腔镜组患者8 a复发率和病死率显著低于开腹组(P<0.05)。结论腹腔镜胃癌根治术治疗老年胃癌具有创伤小、术后疼痛轻、恢复快、复发率和病死率低等优点。

Objective To compare the clinical effect between laparoscopic radical gastrectomy and open radical gastrectomy in elderly patients with gastric cancer. Methods Seventy-seven patients with gastric cancer were selected in the Fourth People＇s Hospital of Wuxi City from March 2005 to March 2008. All the patients were divided into laparoscopic radical gastrectomy group （laparoscope group,36 cases） and open radical gastrectomy group （open group ,41 cases） according to the surgical methods. The operation information, postoperative recovery and the rate of postoperative complications were compared between the two groups. All the patients were followed up for eight years, and the relapse rate and fatality rate were compared between the two groups. Results Compared with open group, the operation time was longer （ P 〈 0.05 ） , the intraoperative bleeding volume was less （ P 〈 0.05 ）, and the length of incision was shorter in laparoscope group （ P 〈 0.05 ）. Compared with open group, the anal exhaust time and hospitalization time were significantly shorter（ P 〈 0.05 ） , and the number of using anal- gesic drugs was significantly less in laparoscope group （ P 〈 0.05 ）. The rate of complication in open group and laparoscope group was 22.0% （9/41） and 5.6% （2/36） respectively, the rate of complication in laparoscope group was significantly lower than that in open group（ P 〈 0.05 ）. The 4-year relapse rate and fatality rate were 12.2% （5/41） and 9.8% （ 3/41 ） in open group, and the 4-year relapse rate and fatality rate were 8.3 % （3/36） and 2.8% （ 1/36 ） in laparoscope group, there was no significant difference in the 4-year relapse rate and fatality rate between the two groups （ P 〉 0.05 ）. The 8-year relapse rate and fatality rate were 34.1% （ 14/41 ） and 22.0% （9/41） in open group ,and the 8-year relapse rate and fatality rate were 13.9% （5/36） and 5.6% （2/36） in laparoscope group, the 8-year relapse rate and fatality rate in laparoscope group were significantly lower than those in open group （ P 〈 0.05 ）. Conclusion Laparoseopic radical gastrectomy in the treatment of patients with gastric cancer has the advantages of less trauma, less postoperative pain ,faster recovery, low recurrence rate and fatality rate.