腹腔镜胃癌根治术治疗老年进展期胃癌的临床疗效分析

Clinical efficacy of laparoscopic radical gastrectomy in elderly patients with advanced gastric cancer

目的:探讨腹腔镜胃癌根治术治疗老年进展期胃癌的临床疗效。方法:研究对象为2013年5月至2015年5月收治的78例老年进展期胃癌患者,其中43例行腹腔镜手术(腹腔镜组),35例行开腹手术(开腹组)。两组患者均行D2根治术。记录并对比两组患者住院时间、术后血红蛋白水平、术中出血量、进食流质时间、离床活动时间、胃管留置时间、术后肛门排气时间、淋巴结清扫数量、术中Pa CO2、手术时间等指标。结果:腹腔镜组出血量显著少于开腹组(P<0.05),两组术中Pa CO2、手术时间及淋巴结清扫数量差异无统计学意义(P>0.05)。腹腔镜组患者血红蛋白显著高于开腹组(P<0.05),且住院时间、进食流质食物时间、离床活动时间、胃管留置时间及术后肛门排气时间均显著早于开腹组(P<0.05)。结论:腹腔镜胃癌根治术可保证根治性治疗及手术安全,并促进老年进展期胃癌患者的术后康复,与开腹胃癌根治术相比,在减少术中出血量、促进术后恢复等方面具有明显优势,值得临床上推广应用。

Objective： To evaluate the clinical efficacy of laparoscopic radical gastrectomy in elderly patients with advanced gastric cancer. Methods： The objects were 78 elderly patients with advanced gastric cancer from May 2013 to May 2015,including 43 patients who underwent laparoscopic radical gastrectomy and 35 patients who underwent open radical gastrectomy. All patients were performed primary tumor resection for D2 resection. The hospitalization time,postoperative hemoglobin levels,blood loss,eating liquid time,ambulation time,stomach tube retention time,anus exhaust time,number of lymph node dissected,intraoperative arterial partial pressure of carbon dioxide（ Pa CO2） and operation time in the 2 groups were recorded and analyzed. Results： During the operation,the blood loss in the laparoscopic group was significantly less than that in the open group（ P 〈 0. 05）. The intraoperative Pa CO2,the operation time and number of lymph node dissected were not significantly different between two groups（ P 〉 0. 05）. After surgery,the hemoglobin levels in the laparoscopic group was significantly higher than that in the open group（ P 〈 0. 05）,with less hospitalization time,eating liquid food time,ambulation time,stomach tube retention time and postoperative flatus when compared with open group（ P〈 0. 05）. Conclusions： Laparoscopic radical gastrectomy is a safe option of complete tumor resection for elderly patients with advanced gastric cancer,which could promote the recovery after surgery and decrease intraoperative blood loss. It should be widely applied clinically.