全腹腔镜胃癌D2根治术治疗高龄胃癌患者的安全性及生存分析

Safety and survival analysis of total laparoscopic gastrectomy with D2 lymph node dissection for gastric cancer in elderly patients

目的:评价全腹腔镜胃癌D2根治术治疗高龄胃癌患者的安全性及对患者生存的分析。方法:采用回顾性病例对照研究的方法,纳入2012年10月到2016年9月在空军军医大学附属唐都医院胃肠外科行手术治疗的70岁以上胃癌患者108例,根据手术方式差异分为腹腔镜组(n=54)和开腹组(n=54)。收集并分析两组患者的临床病理学资料和术后30天内并发症发生情况及生存状况。结果:两组术前一般特征及术后病理学特征比较未见统计学差异(P>0.05)。与开腹组相比,腹腔镜组术中出血量、围手术期输血更少(69.6±44.6 vs 234.1±110.5,P=0.000;27.8%vs 53.7%,P=0.006),术后首次通气时间早(3.0±1.1 vs 3.8±1.1,P=0.000),且术后住院时间短(7.4±3.4 vs 9.3±4.0,P=0.011)。开腹组术后30天内非腹部并发症发生率更高(29.6%vs 9.3%,P=0.007),但两组腹部并发症(18.5%vs 11.1%,P=0.302)和严重并发症比较(7.4%vs 1.9%,P=0.206)未见统计学差异。腹腔镜组1年、2年及3年累计生存率分别为87.6%、80.1%及58.6%,开腹组1年、2年及3年累计生存率分别为84.8%、68.9%和54.3%,组间比较未见统计学差异(P>0.05)。结论:全腹腔镜D2根治术治疗高龄胃癌患者安全可行,且具有术中出血少、术后首次通气时间早、术后住院时间短的优势,患者术后远期生存情况与传统开腹手术相当。

Objective：To evaluate the safety and long-term outcome of total laparoscopic gastrectomy with D2 lymph node dissection in elderly patients with gastric cancer.Methods：A case-control study was conducted in 108 gastric patients who were more than 70 years old.They underwent either totally laparoscopic gastrectomy （LG，n=54） or open gastrectomy （OG，n=54） in Tangdu hospital between October 2012 and September 2016.The clinicopathological information，postoperative complications within 30 days and survival time were collected and analyzed retrospectively.Results：No significantly statistic difference was observed in clinical characteristics and pathological findings between two groups.Compared with OG group，intraoperative blood loss （69.6±44.6 vs 234.1±110.5，P=0.000） and peri-operative blood transfution （27.8% vs 53.7%，P=0.006） were less，time to flatus was earlier （3.0±1.1 vs 3.8±1.1，P=0.000），and hospitalization after surgery was shorter （7.4±3.4 vs 9.3±4.0，P=0.011） in LG group.There was no difference between two groups in abdominal complications （18.5% vs 11.1%，P=0.302） and severe complications （7.4% vs 1.9%，P=0.206），whereas non-abdominal complications occurred more often in OG group （29.6% vs 9.3%，P=0.007）.The 1-year，2-year，and 3-year survival rate of LG group were 87.6%，80.1%，and 58.6%，which were comparable to survival rate of OG group （84.8%，68.9% and 54.3%），respectively （P〉0.05）.Conclusion：Compared with OG，totally laparoscopic gastrectomy with D2 lymph node dissection can be performed safely in elderly patients，with comparable postoperative long-term survival.