完全腹腔镜与开腹全胃D2根治术治疗局部进展期胃上部癌近期疗效比较

Comparison of short-term effect of totally laparoscopy versus open radical total gastrectomy with D2 lymph node dissection on local advanced upper gastric cancer

目的探讨完全腹腔镜全胃D2根治术治疗局部进展期胃上部癌的近期临床疗效。方法回顾性分析山西医科大学附属肿瘤医院2016年6月至2018年6月112例局部进展期胃上部癌行完全腹腔镜全胃D2根治术(全腹腔镜组)或开腹全胃D2根治术(开腹组)患者的临床资料,其中全腹腔镜组54例,开腹组58例,比较两组患者围术期和术后情况。结果符合纳入排除标准的112例患者均顺利完成手术,全腹腔镜组手术时间长于开腹组[(240±47)min比(203±30)min],全腹腔镜组术中出血量少于开腹组[(103±21)ml比(260±34)ml],全腹腔镜组手术切口小[(4.3±0.8)cm比(17.0±1.3)cm],差异均有统计学意义(均P<0.05);两组患者肿瘤距离近端切缘的距离和术中淋巴结清扫数差异均无统计学意义(均P>0.05)。全腹腔镜组患者术后3~5 d疼痛程度较开腹组明显轻,全腹腔镜组术后并发症发生率较开腹组低,全腹腔镜组术后肠道功能恢复时间及住院时间较开腹组短,差异均有统计学意义(均P<0.05)。结论完全腹腔镜全胃D2根治术治疗局部进展期胃上部癌手术安全性高,术后恢复快,术后并发症少,并且淋巴结清扫效果能达到开腹水平。

Objective To explore the short-term effect of totally laparoscopic radical total gastrectomy with D2 lymph node dissection for treatment of local advanced upper gastric cancer. Methods Clinical data of 112 patients with local advanced upper gastric cancer who underwent totally laparoscopic or open radical total gastrectomy with D2 lymph node dissection in Affiliated Cancer Hospital of Shanxi Medical University from June 2016 to June 2018 were analyzed. The patients were divided into totally laparoscopic radical total gastrectomy with D2 lymph node dissection group (totally laparoscopic gastrectomy group, 54 cases) and open surgery radical total gastrectomy with D2 lymph node dissection group (opening gastrectomy group, 58 cases). The perioperative conditions and postoperative pathological conditions between the two groups were compared. Results All the 112 operations were technically successful. Compared with the opening gastrectomy group, the operating time of the totally laparoscopic gastrectomy group was longer [(240±47) min vs.(203±30) min], and the estimated blood loss was reduced [(103±21) ml vs.(260±34) ml], and the length of operative incision on body surface was shorter [(4.3±0.8) cm vs.(17.0±1.3) cm], and the differences between the two groups were statistically significant (all P < 0.05). There were no significant differences in the distance between the upper incision edge and tumor and the number of excised lymph node between the two groups (both P > 0.05). Compared with the opening gastrectomy group, the pain degree in 3-5 d after operation was slighter in the totally laparoscopic gastrectomy group, and the ratio of postoperative complications was lower, and the time of intestinal recovery and postoperative hospital stay was shorter, and the differences between the two groups were statistically significant (all P < 0.05). Conclusion Totally laparoscopic radical total gastrectomy with D2 lymph node dissection for local advanced upper gastric cancer has advantages in operation safety, the time of postoperative recovery and the number of postoperative complications, and the effect of lymph node dissection can reach the level of open surgery.