两种D2淋巴结清扫术治疗进展期胃癌的临床对比研究

Clinical comparative study of two kinds of D2 lymph node dissection operation in the treatment of patients with advanced gastric cancer

目的探讨开腹和腹腔镜D2淋巴结清扫术治疗进展期胃癌疗效及安全性。方法选取本院2016年4月至2019年4月收治的进展期胃癌患者126例,随机分为开放组和微创组,各63例。开放组采用开腹治疗,微创组采用腹腔镜D2淋巴结清扫术治疗。比较两组围手术期临床指标和术后并发症发生率。结果微创组术中操作时间、术中出血量、术后下首次床活动时间、术后首次排气时间、术后首次进流食时间及术后住院时间均显著优于开放组(P<0.05);两组胃周淋巴结清扫数目和总淋巴结清扫数目比较差异无统计学意义;微创组胃动脉周围淋巴结清扫数目显著少于开放组(P<0.05);微创组术后并发症发生率显著低于开放组(P<0.05)。结论腹腔镜D2淋巴结清扫术治疗进展期胃癌具有微创、操作简便、术后恢复快等优势,且能提高淋巴结清扫效果和治疗安全性。

Objective To investigate the clinical effects and safety of open and laparoscopy D2 lymph node dissection in the treatment of patients with advanced gastric cancer.Methods 126 patients with advanced gastric cancer were chosen in the period from April 2016 to April 2019 in our hospital and they were randomly divided into open group and minimally invasive group,with 63 cases in each group.The open group underwent open D2 lymph node dissection operation and minimally invasive group underwent laparoscopy D2 lymph node dissection operation.The clinical index in perioperative period and postoperative complication incidence were compared between two groups.Results The operation time,the amount of bleeding during the operation,the time of the first bed activity after operation,the first exhaust time after the operation,the first feeding time after operation and the hospitalization time after operation in minimally invasive group were significantly better than open group(P<0.05).There was no significant difference in the number of perigastric lymph nodes and total lymph nodes between two groups.The number of lymphadenectomy around gastric artery of minimally invasive group was significantly less than open group(P<0.05).The postoperative complication incidence of minimally invasive group was significantly lower than open group(P<0.05).Conclusion Compared with open D2 lymph node dissection,laparoscopy D2 lymph node dissection in the treatment of patients with advanced gastric cancer possess the advantages including minimally invasive,simple operation and quick postoperative recovery,and can efficiently improve the lymph node dissection effects and treatment safety.