手辅助腹腔镜与腹腔镜辅助胃癌根治术的临床对照研究

Hand-assisted laparoscopic versus laparoscopy-assisted radical gastrectomy:A randomized controlled clinical study

目的探讨手辅助腹腔镜与腹腔镜辅助在胃癌根治中的安全性及临床疗效。方法选取我科2013年6月至2014年12月确诊的101例胃癌患者,随机分为手辅助腹腔镜组和腹腔镜组,其中手辅助腹腔镜组51例,腹腔镜组50例。比较两组患者的手术时间、淋巴结清扫个数、术中失血量、腹部切口长度、术后首次排气时间、术后并发症发生率、术后住院时间和3年生存率。结果手辅助腹腔镜组的手术时间(179±33)min低于腹腔镜组(206±36)min,差异具有统计学意义(P <0.05)。两组患者淋巴结清扫数目、术中失血量、腹部切口长度、胃肠道功能恢复时间和术后并发症差异均无统计学意义。手辅助组和腹腔镜组患者的3年生存率分别为56.8%和64.0%,差异无统计学意义。结论手辅助腹腔镜胃癌根治术和腹腔镜辅助胃癌根治术可以达到相同疗效,但手辅助腹腔镜手术时间更短,学习曲线更短,值得在基层医院推广。

Objective To investigate the safety and clinical efficacy of hand-assisted laparoscopic versus laparoscopy assisted radical gastrectomy for gastric cancer.Methods Perspective study of 101 patients with gastric carcinoma between June 2013 and December 2014 diagnosed in our gastrointestinal department.All patients were randomly divided into the hand-assisted laparoscopic group(n=51)or the laparoscopic group(n=50).The operation time,amount of bleeding and lymph node dissection,abdominal incision length,first ventilation time,incidences of postoperative complications,hospital stay time and 3-year survival rate were compared between the two groups.Results The operation time(179±33)min of the hand-assisted laparoscopic group was lower than that of the laparoscopic group(206±36)min,and the difference was statistically significant between the two groups(P<0.05).However,there was no significant difference between the two groups in the amount of bleeding and lymph node dissection,abdominal incision length,gastrointestinal function recovery time and the incidences of postoperative complications(P>0.05).The 3-year survival rates of patients in the hand-assisted laparoscopic group and the laparoscopic group were 56.8% and 64% respectively,with no significant difference between the two groups.Conclusion Hand-assisted laparoscopic radical gastrectomy and laparoscopic radical gastrectomy can achieve the same effect,but the hand-assisted laparoscopic surgery is shorter and the learning curve is shorter,which is worthy of promotion in primary hospitals.