腹腔镜手术治疗远端进展期胃癌效果观察

Efficacy observation of laparoscopic surgery for treatment of distal advanced gastric cancer

目的 探讨腹腔镜手术治疗远端进展期胃癌患者的效果.方法 对广东医科大学附属医院2015年1月至2017年1月接受远端胃癌D2根治手术治疗的120例进展期胃癌患者临床资料进行回顾性分析.根据手术方法将患者分为腹腔镜组（60例）和开腹组（60例）,采用x2检验、t检验分别比较两组患者手术相关指标、手术根治效果指标及术后恢复情况.结果 腹腔镜组手术时间长于开腹组[（197±21） min比（178±23） min,f=4.759,P＜ 0.001].腹腔镜组患者术中出血量[（111±30）ml比（221±52）ml]、手术切口长度[（6.1±1.3）cm比（17.3±3.2）cm]、术后肛门排气时间[（90±14）h比（110±18）h]、术后下床时间[（2.9±0.8）d比（4.8±1.4）d]、术后进流质饮食时间[（4.3±0.9）d比（5.7±1.2）d]、住院时间[（13.2±2.5）d比（15.5±3.2）d]均少于开腹组（t值分别为14.103、25.117、6.983、9.127、7.230、4.387,均P＜ 0.001）.两组患者手术根治相关指标即清扫淋巴结数目、第一站淋巴结清扫数目、第二站淋巴结清扫数目、切缘远端距离肿瘤距离、切缘近端距离肿瘤距离比较,差异均无统计学意义（t值分别为1.351、0.912、1.240、0.876、0.840,均P＞ 0.05）.腹腔镜组手术并发症发生率低于开腹组[6.67％（4/60）比20.00％（12/60）],差异有统计学意义（χ^2=4.615,P=0.032）.结论 腹腔镜手术治疗远端进展期胃癌患者效果可靠,手术创伤小,术后恢复快,并发症少.

Objective To investigate the therapeutic efficacy of laparoscopic surgery for treatment of the patients with advanced gastric cancer.Methods A total of 120 patients with advanced gastric cancer treated by D2 radical resection of distal gastric cancer from January 2015 to January 2017 in Affiliated Hospital of Guangdong Medical University were retrospectively analyzed.According to the method of operation,the patients were divided into laparoscopic group （60 cases） and laparotomy group （60 cases）.The operation-related indexes,operation curative effect indexes and postoperative recovery were compared between the two groups by using x 2 test and t test.Results The operation time of the laparoscopic group was longer than that of the laparotomy group [（197±21） min vs.（178±23） min,t =4.759,P 〈 0.001].Some parameters in the laparoscopic group were lower than those in the laparotomy group （all P 〈 0.05）,including intraoperative blood loss [（111±30） ml vs.（221±52） ml,t =14.103],the length of the surgical incision[（6.1±1.3） cm vs.（17.3±3.2） cm,t =25.117],postoperative anal evacuation time [（90±14） h vs.（110±18） h,t =6.983],the postoperative bed-out time [（2.9±0.8） d vs.（4.8±1.4） d,t =9.127],the postoperative liquid dietary intake time [（4.3±0.9） d vs.（5.7±1.2） d,t =7.230],and hospital stay time [（13.2±2.5） d vs.（15.5±3.2） d t =4.387].There were no statistical differences in the number of removed lymph nodes,the number of first-site removed lymph nodes,the number of second-site removed lymph nodes,the distance from the distal margin to the tumor,and the distance from the proximal margin to the tumor （t values 1.351,0.912,1.240,0.876,and 0.840 respectively,all P 〉 0.05）;The incidence of operative complications in the laparoscopic group was lower than that in the laparotomy group [6.67 % （4/60） vs.20.00 % （12/60）,χ^2=4.615,P =0.032].Conclusion Laparoscopic surgery in the treatment of advanced gastric cancer patients has a favorable effect,with reliable results,less trauma,postoperative recovery and fewer complications.