基层医院腹腔镜辅助远端胃癌根治术治疗进展期胃癌

Laparoscopic-assisted distal gastrectomy with D2 lymphadenectomy for advanced gastric cancer in primary hospital

目的 :探讨基层医院行腹腔镜辅助远端胃癌D2根治术治疗进展期胃癌的可行性,并与开腹手术作比较。方法:从我院2016年1月至2018年3月期间的进展期胃癌病人中选取合适的研究对象,腹腔镜组与开腹组各40例,回顾性分析近期临床疗效。结果:腹腔镜组的手术时间、出血量以及术后排气恢复时间、术后下床活动时间、术后进食时间分别为(183.71±16.08)min、(64.02±10.69)m L、(3.08±0.61)d、(2.88±0.70)d、(3.10±0.71)d,与开腹组比较,均具有统计学差异(P<0.05)。腹腔镜组术后的淋巴结清扫数和术后病理检查中肿瘤距远、近切缘的距离分别是(30.70±8.84)枚、(4.73±1.16)cm、(7.10±1.14)cm,与开腹组的差异均无统计学意义(P>0.05)。开腹组切口感染和肺部感染的发生率高于腹腔镜组(P<0.05),但两组吻合口出血、吻合口漏及胃动力障碍的发生率无统计学差异(P>0.05)。结论 :腹腔镜辅助手术出血少、恢复快,具有与开腹手术相似的治疗效果。

Objective To explore the feasibility of laparoscopic-assisted distal gastrectomy with D2 lymphadenectomy for advanced gastric cancer in primary hospital and examine the outcomes compared to open surgery.Methods The patients with advanced gastric cancer were divided into laparoscopic group and open group each 40 cases in our hospital from January 2016 to March 2018.Retrospective analysis was performed for short-term clinical results.Results The operating time,blood loss,first flatus time,out of bed time and first feeding time in laparoscopic group were（183.71 ±16.08） min,（64.02±10.69） mL,（3.08±0.61） d,（2.88±0.70） d,（3.10±0.71） d,respectively with the statistical difference when compared to those in open group（P〈0.05）.The retrieved lymph node and the length of distal and proximal resection margins away from the cancer were（30.70 ±8.84）,（4.73 ±1.16） cm and（7.10 ±1.14） cm without significant difference statistically between two groups（P〉0.05）.The rate of incision infection and pulmonary infection in open group was higher than that in laparoscopic group（P〈0.05）.However,the difference between two groups was not present in the anastomotic bleeding and leakage and gastroparalysis（P 〉0.05）.Conclusion Laparoscopic-assisted gastrectomy has similar curative effect compared to open surgery with the advantages of less blood loss and quicker recovery.