腹腔镜辅助胃上部癌根治手术的可行性及安全性分析

Feasibility and safety of laparoscopic assisted radical resection of upper gastric cancer

目的探讨腹腔镜辅助手术治疗胃上部癌的可行性及安全性。方法选择2013年1月—2014年1月江苏省盐城市第二人民医院普外科接受手术治疗的胃上部癌98例,按照随机数字表法分为观察组49例和对照组49例。比较2组患者的手术情况,包括手术时间、术中出血量、淋巴结清除数量、切口长度、胃肠道功能恢复时间、首次进食时间、术后住院时间及下床活动时间;术后并发症情况,包括切口感染、术后粘连性肠梗阻、肺部感染、吻合口瘘、反流性食管炎及十二指肠残端瘘;术后随访观察2组患者生存情况。结果观察组手术时间、淋巴结清扫数量显著高于对照组,术中出血量、切口长度明显低于对照组,2组间比较差异具有统计学意义(t=3.894、6.149、11.946、24.466,P=0.000);观察组胃肠道恢复时间、首次进食时间、住院时间及下床活动时间均明显早于对照组(t=5.626、5.938、8.743、4.81 1,P=0.000);2组患者术后均发生切口感染、术后粘连性肠梗阻、肺部感染、吻合口瘘、十二指肠残端瘘及反流性食管炎等不良症状,2组比较差异无统计学意义(x^2=2.020、2.163、0.413、0.000、2.020、1.619,P>0.05)。2组患者随访1~36个月,中位随访时间20个月,观察组3年生存率为40.8%,对照组3年生存率为38.8%,2组间比较差异无统计学意义(x^2=0.084,P=0.773)。结论腹腔镜辅助治疗胃上部癌是一种安全可行的手术方法,可取得与传统开腹手术相同的根治效果,手术创伤小,有利患者术后恢复。

Objective To investigate the feasibility and safety of laparoscopic assisted surgery for upper gastric cancer.Methods Ninety-eight patients with gastric cancer who underwent surgical treatment in Department of general surgery in Yancheng Second People＇s Hospital of Jiangsu province from January 2013 to January 2014 were divided into observation group（n =49） and control group（n =49） according to the random number table method.The operation situation of the 2 groups were compared,including operation time,intraoperative blood loss,number of lymph node dissection,incision length,gastrointestinal function recovery time,the first eating time,postoperative hospitalization time and ambulation time;postoperative complications,including incision infection,postoperative ileus,pulmonary infection,anastomosis fistula,reflux esophagitis and duodenal＇ stump fistula;postoperative follow-up of 2 group patients＇ survival.Results The operation time of the observation group,the number of lymph nodes was significantly higher than the control group,intraoperative blood loss,incision length was significantly lower than the control group,with significant differences between the 2 groups（t = 3.894,t =6.149,t = 11.946,t =24.466,P =0.000）;the observation group recovery time of gastrointestinal tract,the first feeding time,hospitalization time and ambulation time were significantly earlier than the control group（t =5.626,t =5.938,t =8.743,t =4.811,P =0.000）;the 2 groups of patients occurred incision infection,postoperative adhesive intestinal obstruction,pulmonary infection,anastomotic fistula,duodenal stump fistula and reflux food tube inflammation and other adverse symptoms,the difference between the 2 groups was not statistically significant（χ^2=2.020,χ^2=2.163,χ^2=0.413,χ^2 =0.000,χ^2 =2.020,χ^2 = 1.619,P〉0.05）.2 groups of patients were followed up for 1-36 months,the median follow-up time was 20 months,the observation group 3 years survival rate was 40.8%,control group 3 years survival rate was 38.8%,there was no significant difference between the 2 groups（χ^2 =0.084,P = 0.773）.Conclusion The laparoscopic assisted treatment for patients with upper gastric cancer is a safe and feasible surgical method,which can achieve the same curative effect as the traditional open surgery.