高龄患者完全腹腔镜与开腹远端胃癌根治性切除术近期疗效分析

Short-term curative effect of totally laparoscopic and open radical distal gastrectomy for elderly patients with distal gastric cancer

目的对比高龄患者远端胃癌行完全腹腔镜及开腹远端胃癌根治性切除术的近期疗效。方法选取2015年10月—2016年6月在海军总医院就诊的年龄≥70岁的远端胃癌患者77例,分为2组,腹腔镜组41例行完全腹腔镜下远端胃癌根治性切除术,开腹组36例行开腹远端胃癌根治性切除术,比较2组手术时间、术中失血量、淋巴结清扫数目、术后排气时间、术后住院时间、切缘阳性率、术后并发症(吻合口瘘、吻合口梗阻、肺部感染)发生率。结果腹腔镜组手术时间长于开腹组(P<0.05),术中失血量少于开腹组(P<0.05),术后排气时间、术后住院时间均低于开腹组(P<0.05),淋巴结清扫数目多于开腹组(P<0.05);切缘阳性率、术后吻合口瘘、吻合口梗阻、肺部感染发生率2组差异均无统计学意义(P>0.05)。结论高龄远端胃癌患者行完全腹腔镜下远端胃癌根治性切除术安全、可靠、创伤小,近期疗效优于开腹手术。

Objective To investigate the short-term curative effect of totally laparoscopic and open radical distal gastrectomy for elderly patients with distal gastric cancer. Methods Seventy-seven cases（ Age≥70） between October 2015 and June 2016 were divided into Group TLDG（ n = 41）and Group ODG（ n = 36）. Group TLDG received total laparoscopic radical distal gastrectomy and Group ODG received open radical distal gastrectomy. The operation duration,the blood loss volume,the number of resected lymph nodes,the time of exsufflation and hospitalization after operation,the rate of pathological positive margin,the incidence of postoperative complications（ anastomotic fistula,anastomotic stenosis and pulmonary infection） were compared between two groups. Results The operation duration was longer in Group TLDG than in Group ODG（ P〈0. 05）; the blood loss volume was less in Group TLDG than in Group ODG（ P〈0. 05）; the number of resected lymph nodes was more in Group TLDG than in Group ODG（ P〈0. 05）; the time of exsufflation and hospitalization after operation were shorter in Group TLDG than in Group ODG（ P〈0. 05）. There were no significant differences in the rate of pathological positive margin and the incidence of anastomotic fistula,anastomotic stenosis and pulmonary infection（ P〉0. 05）. Conclusion For elderly patients with distal gastric cancer,TLDG is safe and reliable with small trauma,and the short-term effect is much better than ODG.