原发性胃癌腹腔镜下淋巴结清扫的效果分析

Analysis of laparoscopic lymph node dissection for primary gastric cancer

目的比较原发性胃癌患者腹腔镜下根治术与传统开腹胃癌根治术对淋巴结清扫的效果,为临床胃癌患者根治术的选择提供参考。方法选择2012年5月-2017年12月在该院择期行胃癌根治术的患者126例为研究对象,根据其手术方式的不同分为观察组和对照组,其中观察组65例,采用腹腔镜根治术;对照组61例,采用开腹根治术。比较两组患者淋巴结清扫情况、切口长度、术中失血量、手术时间、术后住院时间、术后下床活动时间、排气时间、术后并发症及肿瘤复发率。结果观察组与对照组在清扫淋巴结总数上差异无统计学意义(t=-0.89,P=0.373);在第1站清扫数上差异无统计学意义(t=-0.23,P=0.815);在第2站清扫数上差异无统计学意义(t=-1.71,P=0.089),腹腔镜手术少于开腹手术。观察组患者的切口长度、术中失血量、术后住院时间、术后下床活动时间及排气时间明显小于对照组,差异均有统计学意义(P<0.05);观察组患者的手术时间长于对照组患者,差异有统计学意义(P<0.05)。观察组并发症发生率为6.2%,其中切口感染1例,胸腔积液1例,肺部感染2例。对照组并发症的发生率为9.8%,其中切口感染2例,胸腔积液1例,腹腔出血1例,肺部感染2例,两组比较,差异无统计学意义(χ2=0.58,P=0.445)。结论腹腔镜胃癌根治术可达到与开腹手术同样的淋巴结清扫效果,且具有创伤小和恢复快等优点,可用于治疗原发性胃癌。

Objective To compare the effect of laparoscopic radical gastrectomy and traditional radical gastrectomy for lymph node dissection in patients with primary gastric cancer,and provide a reference for the choice of radical surgery for the patients with gastric cancer.Methods 126 patients who underwent radical gastrectomy for gastric cancer from May 2012 to December 2017 were selected as the study subjects.According to the different surgical methods,the patients were divided into observation group and control group.Among them,65 cases in the observation group were treated with laparoscopic radical surgery,and 61 cases in the control group were treated with open radical operation.The two groups were compared with the lymph node dissection,the length of the incision,the amount of blood loss,the time of operation,the time of hospitalization after operation,the time after the operation,the time of discharge from the bed,the time of exhaust,the postoperative complications and the recurrence rate of the tumor.Results There was no significant difference in the total number of lymph nodes between the observation group and the control group on the total number of lymph nodes(t=-0.89,P=0.373),and There was no statistically significant difference between the first and two stations(t=-0.23,-1.71,P=0.815,0.089).The length of the incision,the amount of blood loss,the time of hospitalization,the time of postoperative hospital stay,the time and the exhaust time were all smaller than those of the control group(P<0.05),and the operation time of the patients in the observation group was longer than that of the control group,the difference was statistically significant(P<0.05).The complication rate of the observation group was 6.2%,including 1 cases of incision infection,1 cases of pleural effusion,and 2 cases of pulmonary infection.The incidence of complications in the control group was 9.8%,including incision infection in 2 cases,pleural effusion in 1 case,abdominal bleeding in 1 cases,and pulmonary infection in 2 cases.There was no significant difference between the two groups(χ^2=0.58,P=0.445).Conclusion Laparoscopic radical gastrectomy can achieve the same effect of lymph node dissection as open surgery,and it has the advantages of small trauma and quick recovery.It can be used for the treatment of primary gastric cancer.