腹腔镜下远端胃癌D2根治术淋巴结清扫技术的研究

Clinical efficacy analysis of lymph node dissection in laparoscopic D2 radical gastrectomy for Distal Gastric Cancer

目的探讨腹腔镜远端胃癌淋巴结清扫入路的近期临床效果。方法回顾性分析我院2014年1月至2017年12月所收治的130例远端胃癌患者的临床资料,分为腹腔镜组及开腹组,腹腔镜组淋巴结清扫顺序为6组→4sb组、4d组→8a组、11p组、7组、9组→12a组、5组、1组、3组,比较两组间手术时长、淋巴结清扫数目、术中出血量、住院费用、术后恢复情况及近期并发症,并进行统计分析。结果腹腔镜组在手术时间(191.21±24.90)min、淋巴结清扫数目(21.44±5.22)枚、住院费用(4.90±0.47)万元方面,与开腹组差异无统计学意义(P <0.05)。腹腔镜组在术中出血量(81.77±33.27)mL、切口长度(5.34±1.21)cm、术后下床活动时间(34.77±11.51)h、使用止痛药物次数(3.03±1.07)次及住院时间(23.19±5.91)d方面均低于开腹组且差异均具有统计学意义(P <0.05)。结论本研究的腹腔镜远端胃癌淋巴结清扫顺序,在根治效果方面完全能达到开腹手术水平,手术时间与开腹相近,近期效果显著,在充分掌握适应证的前提下,应提倡应用。

Objective To explore the recent clinical efficacy of lymph node dissection in laparoscopy as-sisted radical gastrectomy for distal Gastric Cancer.Methods The clinical data of 130 patients with distal gastric cancer treated in our hospital from January 2014 to December 2017 were retrospectively analyzed.It was divided into laparoscopy group and open abdominal group.The order of lymph node dissection in the laparoscopic group to stand by group 6→4sb、4d→8a、11p、7、9→12a、5、1、3.Operation time,numbers of lymph nodes,blood loss,hos-pital costs,recovery condition after operation,and postoperative complication was compared between the two groups.Results In laparoscopic group,Operation time(191.21±24.90)min,number of dissected lymph nodes(21.44±5.22),hospital costs(4.90±0.47)ten thousand Yuan,were no difference with the open abdominal group(P>0.05).In laparoscopic group,blood loss(81.77±33.27)mL,the length of the incision(5.34±1.21)cm,postoperative activity out of bed time(34.77±11.51)hours,used pain medications(3.03±1.07)times,hospital stay(23.19±5.91 days),was lower than the open abdominal group(P<0.05).Conclusions The order of laparo-scopic distal gastric cancer lymph node dissection in our research,it can achieve the level of laparotomy in radical effect.The operation times were close to the open abdominal group.Recent effect is significant.The application should be promoted under the condition of adequate indications.