腹腔镜全胃D2根治术与开腹手术治疗胃上部癌的临床效果比较

Clinical comparison of laparoscopic total gastric D2 radical resection and laparotomy in the treatment of upper gastric cancer

目的 比较腹腔镜全胃D2根治术与开腹手术治疗胃上部癌的临床效果。方法选取2017年6月至2018年2月濮阳市惠民医院收治的104例胃上部癌患者,按照随机数字表分为研究组与对照组各52例。研究组采取腹腔镜全胃D2根治术,对照组采取传统开腹手术,比较两组的治疗结果及术后并发症发生情况。结果研究组手术时间长于对照组[(4.43±1.37)h vs.(3.85±1.30)h],差异有统计学意义( P = 0.029),但切口长度[(5.16±1.70)cm vs.(17.04±2.68)cm]、出血量[(155.36± 12.58)ml vs.(307.26±14.55)ml]、胃肠功能恢复时间[(3.82±1.26)d vs.(4.40±1.45)d]、首次进食时间[(5.07±1.55)d vs.(5.83±1.72)d]及住院时间[(10.81±3.13)d vs.(12.75±3.79)d]均小于对照组,差异有统计学意义( P < 0.05)。两组的淋巴结清扫数量差异无统计学意义( P > 0.05)。治疗前两组的躯体症状、心理症状、生理症状及睡眠质量评分无显著差别( P > 0.05),治疗后,研究组上述各项评分均高于对照组( P < 0.05);研究组术后并发症发生率低于对照组(5.77% vs. 17.31%,χ^2=6.523, P < 0.05);术后6个月,研究组的生存率为96.15%(50/52),对照组的生存率为98.08%(51/52),两组生存率差异无统计学意义(χ^2=0.343, P > 0.05)。结论胃上部癌患者采取腹腔镜全胃D2根治术可取得与传统开腹手术同样的根治效果,同时可明显缩短住院时间,利于病情快速恢复,改善生活质量,减少并发症发生率,安全性高。

Objective To compare the clinical effects of laparoscopic total gastric D2 radical resection and open surgery in the treatment of upper gastric cancer. Methods One hundred and four patients with upper gastric cancer admitted to Huimin Hospital of Puyang City from June 2017 to February 2018 were randomly divided into study group and control group with 52 cases each. Laparoscopic total gastric D2 radical resection was performed in the study group, while traditional open surgery was performed in the control group. Results The operation time of the study group was longer than that of the control group [(4.43±1.37) h vs.(3.85±1.30) h], the difference was statistically significant ( t = 2.215, P = 0.029), but the length of incision [(5.16±1.70) cm vs.(17.04±2.68) cm], the amount of bleeding [(155.36±12.58) ml vs.(307.26±14.55) ml], the recovery time of gastrointestinal function [(3.82±1.26) d vs.(4.40±1.45) d], and the time of first feeding[(5.07± 1.55)d vs.(5.83±1.72) d and hospitalization time [(10.81 ±3.13) d vs.(12.75 ±3.79) d] were less than those of the control group, the difference was statistically significant ( P < 0.05). There was no significant difference in the number of lymph node dissection and the scores of somatic symptoms, psychological symptoms, physiological symptoms and sleep quality between the two groups before treatment ( P > 0.05). After treatment, the scores in the study group were higher than those in the control group ( P < 0.05);the incidence of complications in the study group was lower than that in the control group (5.77% vs. 17.31%,χ^2=6.523, P < 0.05);and the survival rate in the study group was 96.15%(50/52), compared with that in the control group 6 months after operation. The survival rate of group A was 98.08%(51/52), and there was no significant difference between the two groups (χ^2=0.343, P > 0.05). Conclusions Laparoscopic total gastric D2 radical resection for upper gastric cancer can achieve the same radical effect as traditional open surgery, and shorten the hospital stay, facilitate the rapid recovery of the disease, improve the quality of life, reduce the incidence of complications with high safety.