腹腔镜辅助胃癌根治术应用于进展期胃癌的疗效分析

The clinical value of laparoscopic assisted radical gastrectomy in the treatment of locally advanced gastric cancer

目的探讨腹腔镜微创技术应用于进展期胃癌的疗效。方法回顾性分析淮南东方医院集团总院普外科自2014年1月至2018年12月期间收治的115例进展期胃癌患者的完整临床资料,根据手术方式分为腹腔镜辅助手术组(简称腹腔镜组)以及传统开放手术组(简称开腹组),比较2组患者术中指标、术后并发症发生情况和患者恢复情况,以及术后近远期疗效。结果 115例患者中腹腔镜组52例,开腹组63例,2组患者术前的一般资料比较其差异无统计学意义(P>0.05)。腹腔镜组术中出血量、术后进食时间和术后住院时间少于或短于开腹手术组,差异均有统计学意义(P<0.05);腹腔镜组患者术后第2天白细胞和中性粒细胞计数显著低于开腹组患者(P<0.05),血清白蛋白浓度显著高于开腹组患者(P<0.05));腹腔镜组患者术中淋巴结检出数多于开腹组患者,差异具有统计学意义(P<0.05)。2组患者的手术时间和术后并发症发生情况比较其差异均无统计学意义(P>0.05)。本组115例患者中有110例患者获得随访,随访率为95.7%;随访时间6~48个月,中位随访时间12.4个月;开腹组术后无病生存期(12.2±6.5)个月,腹腔镜组无病生存期(13.5±7.4)个月,2组比较差异无统计学意义(P>0.05)。结论腹腔镜技术在应用于进展期胃癌的手术治疗中具有术中出血量较少、手术创伤小以及术后恢复较快的微创优势,其淋巴结清扫程度优于开腹手术,其疗效与开腹手术相当。

Objective To assess the outcomes of laparoscopy-assisted surgery for treatment of advanced gastric cancer. Methods A total of 115 patients with advanced gastric cancer were included between January 2014 and December 2018 were analyzed retroprospectively, the patients were divided into two groups: open surgery group (OS group, n=63) and laparoscopy-assisted surgery group (LAS group, n=52). Baseline characteristics, intraoperative parameters and postoperative items, and long-term efficacy were compared between the two groups. Results There was no significant difference in preoperative baseline data including gender, age and preoperative serum parameters between the two groups (P>0.05). Intraoperative blood loss in the LAS group was significantly less than that in the OS group (P<0.05). In addition, the first feeding time after operation and postoperative hospital stay in the LAS group were significantly shorter than the OS group (P<0.05). Furthermore, numbers of white blood cells and neutrophils in the LAS group were fewer than that in the OS group at postoperative 2 days (P<0.05);the level of serum albumin in the LAS group was higher than that OS group (P<0.05). The number of lymph nodes detected during operation in the LAS group was more than that in the OS group (P<0.05). Operative time and occurrence of postoperative complications were not statistically significant between the two groups (P>0.05). One hundred and ten of 115 patients were followed- up, the follow-up rate was 95.7%. The follow-up time ranged from 6 to 48 months, with a median follow-up time of 12.4 months. The disease-free survival time of the OS group was 12.2±6.5 months, while that of the LAS group was 13.5±7.4 months.There was no significant difference between the two groups (P>0.05). Conclusions Laparoscopic technique in treatment of advanced gastric cancer has the minimally invasive advantage, less intraoperative blood loss, less surgical trauma, and faster postoperative recovery in comparing to the traditional open surgery. Also the lymph node dissection is superior to open surgery. The curative effect is comparable to that of open surgery.