进展期贲门癌手助腹腔镜根治术的安全性及疗效评价

Open vs hand-assisted laparoscopic total gastric resection with D2 lymph node dissection for cardiaccarcinoma

目的探讨对进展期贲门癌患者施行手助腹腔镜手术的安全性与可行性。方法回顾性分析2013年10月至2014年10月河南省人民医院行贲门癌根治术174例患者的临床资料，依据手术方式分为手助腹腔镜组和开腹组。结果开腹组清扫淋巴结（32±10）个，手助腹腔镜组清扫淋巴结（28±9）个，两组相比差异无统计学意义（t=0．05，P=0．541）；两组清扫第10组淋巴结的数量[（10±3）个比（9±2）个，t=0．09，P=0．123]和第11d组淋巴结的数量[（7±2）个比（8±1）个，t=0．09，P=0．144]相比差异均无统计学意义；开腹组食管切除长度为（4．0±1．2）cm，手助腹腔镜组为（4．1±1．0）cm，两组相比差异无统计学意义（t=0．95，P=0．147）。开腹组中2例患者术中病理切缘阳性，中转为胸腹联合肿瘤切除。手助腹腔镜组手术时间比开腹组长[（295±37）min比（215±23）min，t=3．78，P=0．004]、手术出血量少[（110±17）m1比（345±95）ml，t=4．95，P=0．011]、术后住院时间短[（8．7±0．6）d比（14．3±2．1）d，t=0．26，P=0．031]。结论与开腹贲门癌根治手术相比．在保证手术安全和肿瘤根治的基础上，手助腹腔镜手术具备创伤小、恢复快的优势。

Objective To investigate the feasibility and safety of hand assisted laparoscopic total gastrectomy with 132 lymphadenectomy for advanced cardiac cancer compared with open surgery. Methods 174 patients suffering cardiac, upper, middle or whole gastric cancer operated in our department from October 2013 to October 2014 were divided into open surgery group and laparoscopic group. Perioperative parameters were compared between the two groups. Results Patients in ]oparoscopic group were associated with significantly less operative blood loss [ （ 110 ± 17 ） ml vs. （ 345 ± 95 ） ml, t = 4. 95, P = 0. 011 ] , and shorter postoperative hospital stay [ （ 8.7 ± 0. 6） d vs. （ 14. 3 ± 2. 1 ） d, t = 0. 26, P = 0. 031 ], but longer operative time [ （295 ± 37 ） rain vs. （ 215 ± 23 ） min, t = 3.78, P = 0. 004 ], compared with that of open surgery. There was no significant difference in the numbers of lymph node dissection between the two groups. Esophagus resection length in open group was （4.0 ± 1.2） cm,and that was （4. 1 ± 1.0） cm in laparoscopic group （t = 0. 95 ,P = 0. 147 ）. Two patients in open group had positive margins and underwent thoracoabdominal resection. There was no difference in major complications between the two groups. Conclusion Hand assisted laparoscopic total gastrectomy for advanced cardiac carcinoma is a safe, feasible, and oncologically sound procedure compared to open procedure.