开腹与腹腔镜胃癌D2根治术治疗进展期胃癌的效果及预后对比

Therapeutic effect of open vs laparoscopic gastrectomy with D2 lymph node dissection for advanced gastric cancer and the prognosis

目的探讨开腹与腹腔镜胃癌D2根治术治疗进展期胃癌的临床效果.方法根据治疗方法不同将120例进展期胃癌患者分为开腹组与腹腔镜组,每组60例.开腹组患者行开腹胃癌D2根治术,腹腔镜组患者行腹腔镜胃癌D2根治术.比较两组患者的手术相关指标、手术相关并发症发生情况及无瘤生存结局.结果腹腔镜组患者的手术时间明显长于开腹组,术中出血量明显少于开腹组,术后住院时间明显短于开腹组,差异均有统计学意义(P﹤0.01);腹腔镜组患者的淋巴结清扫数目、第10组和第11组淋巴结清扫数目、淋巴结转移阳性例数、手术相关并发症总发生率、3年无瘤生存结局与开腹组比较,差异均无统计学意义(P﹥0.05).结论开腹与腹腔镜胃癌D2根治术治疗进展期胃癌患者的手术效果及预后情况基本相当,而腹腔镜手术的主要优势在于减小手术创伤.

Objective To investigate the clinical effect of open gastrectomy and laparoscopic gastrectomy with D2 lymph node dissection in the treatment of advanced gastric cancer. Method According to different treatment methods, 120 patients with advanced gastric cancer were included and assigned into open surgery group and laparoscopic surgery group, containing 60 cases in each. The open surgery group was given open gastrectomy with D2 lymph node dissection, while the laparoscopic surgery group was administered with laparoscopic gastrectomy with D2 lymph node dissection. The surgical indexes, surgery-related complications, and tumor-free survival were compared between the two groups. Result The operative time of laparoscopic surgery group was significantly longer than that in the open surgery group, while with less intraoperative blood loss and shorter postoperative hospital stay, showing statistically significant differences (P<0.01);the number of dissected lymph nodes, number of dissected stations 10 and 11 lymph nodes, number of cases with positive lymph node metastases, overall incidence of surgery-related complications, and 3-year tumor-free survival outcome in laparoscopic gastrectomy group were all similar to that in the open surgery group (P>0.05). Conclusion The surgical outcome and prognosis of advanced gastric cancer patients administered with open or laparoscopic gastrectomy with D2 lymph node dissection are basically comparable, and the main advantage of laparoscopic surgery is the reduced surgical wound.