腹腔镜辅助下D2根治术治疗远端胃癌的临床观察

Clinical observation on laparoscopic assisted D2 radical gastrectomy for distal gastric carcinoma

目的观察腹腔镜辅助下D2根治术治疗远端胃癌的临床效果。方法90例远端胃癌患者,以随机数字表法分为参照组与观察组,每组45例。参照组行开腹D2根治术治疗,观察组行腹腔镜辅助下D2根治术。比较两组患者手术用时、术中出血量、术中输血率、胃肠功能恢复时间、流食进食时间、半流食进食时间、首次下床时间、出院时间、术后并发症发生情况。结果观察组手术用时(2.67±0.23)h长于参照组的(2.31±0.21)h,术中出血量(123.40±20.20)ml少于参照组的(210.75±23.40)ml,术中输血率8.89%低于参照组的31.11%,差异具有统计学意义(P<0.05)。观察组患者术后胃肠功能恢复时间、流食进食时间、半流食进食时间、首次下床时间及出院时间均短于参照组,差异有统计学意义(P<0.05)。观察组术后切口感染、肺部感染、肠梗阻、胃无力、吻合口出血、淋巴漏发生率与参照组比较,差异无统计学意义(P>0.05)。结论远端胃癌行腹腔镜辅助下D2根治术治疗,手术用时稍长于开腹手术,但手术创伤小,术中出血少,术后胃肠道功能恢复快速,加速患者术后康复出院,且无明显并发症影响,手术安全性较高。

Objective To observe the clinical effect of endoscopic assisted D2 radical gastrectomy for distal gastric carcinoma.Methods A total of 90 patients with distal gastric carcinoma were divided into reference group and observation group according to random numerical table,with 45 cases in each group.The reference group was treated with open D2 radical gastrectomy,and the observation group was treated with laparoscopic D2 radical gastrectomy.The operation time,intraoperative blood loss,intraoperative blood transfusion rate,gastrointestinal function recovery time,liquid feeding time,semi-liquid feeding time,fist-time off-bed activity time,time to discharge and occurrence of postoperative complications were compared between the two groups.Results The operation time(2.67±0.23)h of the observation group was longer than(2.31±0.21)h of the reference group,intraoperative blood loss(123.40±20.20)ml was less than(210.75±23.40)ml of the reference group,and intraoperative blood transfusion rate 8.89%was lower than 31.11%of the reference group,and the difference was statistically significant(P<0.05).The gastrointestinal function recovery time,liquid feeding time,semi-liquid feeding time,fist-time off-bed activity time and time to discharge of the observation group were all shorter than those of the reference group,and the difference was statistically significant(P<0.05).The incidence of postoperative incision infection,pulmonary infection,intestinal obstruction,gastric weakness,anastomotic bleeding and lymphatic leakage of the observation group had no statistically significant difference compared with those of the reference group(P>0.05).Conclusion Laparoscopic assisted D2 radical gastrectomy for distal gastric cancer takes a little longer than open surgery,but it has the advantages of less trauma,less intraoperative blood loss,rapid recovery of gastrointestinal function,faster recovery and discharge and high safety without obvious complications.