腹腔镜辅助进展期胃癌D2根治术的临床疗效及预后分析

Clinical efficacy and prognosis of laparoscopic assisted radical gastrectomy of D2 for advanced gastric cancer

目的探讨腹腔镜辅助进展期胃癌D2根治术的临床疗效及预后情况。方法回顾性分析2011年至2013年确诊为进展期胃癌并行胃癌根治术的患者73例,根据患者手术方式不同将患者分为开腹组(34例)与腔镜组(39例),采用SPSS24.0进行统计分析,术中术后各个指标用(x±s)表示,采用独立t检验;术后并发症比较采用卡方检验,术后生存情况比较采用Kaplan-Meier法;以P<0.05为差异具有统计学意义。结果与开腹组比较,腹腔镜组患者手术时间显著升高(P<0.05),术中出血量显著减少(P<0.05);腹腔镜组患者住院时间显著降低(P<0.05)。开腹组平均生存时间为(53.4±4.3)个月,1、3、5年生存率分别为94.0%,69.8%,63.7%;腔镜组平均生存时间为(50.9±4.6)个月,1,3,5年生存率92.3%,55.4%,50.2%;两组患者平均生存时间和累积生存率差异无统计学意义(F=0.180,P=0.672)。结论腹腔镜D2胃癌根治术淋巴结清扫效果满意,术后5年生存率与开腹术相比较无显著差异,且术中出血量、术后住院时间短,安全可行,值得临床推广。

Objective To investigate the clinical efficacy and prognosis of laparoscopic assisted radical gastrectomy of D2 for advanced gastric cancer. Methods The 73 patients with advanced gastric cancer and treated in our hospital from 2011 to 2013 were retrospectively analyzed . Patients were divided into open group （34 cases） and laparoscopic group （39 cases） according to different surgical methods. SPSS 24.0 statistical software package was used for data analysis. Intraoperative and postoperative indicators were expressed by （ ±s） , and compared with t test. The postoperative complications were compared with chi square test. Postoperative survival was compared with Kaplan-Meier method. The difference of P 〈0.05 was statistically significant. Results Compared with the open group, the operative time of the laparoscopic group was significantly increased （ P 〈0.05）, and the intraoperative blood loss was significantly reduced （ P 〈0.05） . The length of stay in the laparoscopic group was significantly lower （ P 〈0.05）. The average survival time of the laparotomy group was （53.4 ＋ 4.3） months, and the 1, 3 and 5 year survival rates were 94%, 69.8% and 63.7% respectively. The mean survival time of the endoscopic group was （50.9＋4.6） months, 1, 3, and 5 years survival rate 92.3%, 55.4%, 50.2%. There was no significant difference in average survival time and cumulative survival rate between the two groups （ F=0.180, P =0.672）. Conclusion Laparoscopic D2 radical gastrectomy has satisfactory curative effect. The postoperative five year survival rate is similar compared with open surgery, and the intraoperative blood loss and postoperative hospital stay were shorter. It is safe and feasible and worthy of clinical promotion.