腹腔镜辅助远端胃癌D2根治术的疗效及安全性探讨

Clinical efficacy and safety of 1aparoscopy-assisted distal gastrectomy for gastric cancer

摘要:

目的??探讨腹腔镜辅助远端胃癌D2根治术（LADG）治疗进展期胃癌的临床疗效和安全性。方法?回顾性分析198例手术治疗的进展期胃癌患者的临床资料和随访资料，依手术方式将患者分为开腹组（n =101）和腹腔镜组（n =97），比较两组患者术中情况、术后并发症及生存质量。结果?腹腔镜组与开腹组间手术时间[（226.30±36.40）vs（220.50±29.90）min，t =1.23，P =0.221]、淋巴结清扫数目[（22.01±4.99）vs（20.69±4.53）个，t =1.95，P =0.053]差异无统计学意义；腹腔镜组术中出血量少于开腹组[（114.50±20.30）vs（168.30±40.04）ml，t =11.77，P =0.000]；胃肠功能恢复时间低于开腹组[（72.30±7.91）vs （84.05±9.04）h，t =9.72，P =0.000]；住院天数低于开腹组[（8.89±1.57）vs（10.36±2.65）d，t =4.72，P =0.000]；腹腔镜组、开腹组术后肿瘤近端切缘[（5.07±2.04）vs（4.85±1.98）cm，t =0.77，P =0.442]，远端切缘[（4.33±1.90）vs（3.90±2.02）cm，t =1.54，P =0.125]差异无统计学意义；腹腔镜组和开腹组患者术后并发症发生率分别为9例（9.27%）和8例（7.92%），差异无统计学意义（χ2=0.01，P =0.907）；腹腔镜组术后7天Karnofsky评分（KPS）高于开腹组[（79.33±15.54）vs（73.49±13.37）分，t =2.84，P =0.005]；术后30天两组患者KPS评分差异无统计学意义[（90.83±8.36）vs（89.57±7.98）分，t =1.09，P =0.279）。结论?LADG治疗进展期胃癌与开腹手术有相同的临床疗效，但其对患者创伤小，患者近期生存质量高于开腹组。

Abstract:

Objective?To evaluate the clinical efficacy and safety of 1aparoscopy-assisted distal gastrectomy (LADG) for patients with advanced gastric cancer.?Methods?Clinical data of 198 cases with advanced gastric cancer were retrospectively analyzed. Based on the surgical approach, patients were divided into laparotomy group (n = 101) and laparoscopic group (n = 97), and the intraoperative situation, postoperative complications and quality of life were compared.?Results?There were no statistical differences in operation time [(226.30 ± 36.40) vs (220.50 ± 29.90) min, t = 1.23, P = 0.221)], number of lymph node cleaning [(22.01 ± 4.99) vs (20.69 ± 4.53), t = 1.95, P = 0.053] between the two groups; the blood loss of laparoscopy group was less than the laparotomy group [(114.50 ± 20.30) vs (168.30 ± 40.04) ml, t = 11.77, P = 0.000]; gastrointestinal function recovery time of laparoscopy group was less than laparotomy group [(72.30 ± 7.91) vs (84.05 ± 9.04) h, t = 9.72, P = 0.000); hospital stay of laparoscopy group was less than the laparotomy group [(8.89 ± 1.57) vs (10.36 ± 2.65) d, t = 4.72, P = 0.000]; there were no statistical differences in the tumor proximal cut end [(5.07 ± 2.04) vs (4.85 ± 1.98) cm, t = 0.77, P = 0.442) and margin of distal [(4.33 ± 1.90) vs (3.90 ± 2.02) cm, t = 1.54, P = 0.125] between the two groups; the postoperative complication rate of laparoscopy group and laparotomy group was 9.27% (9 cases ) and 7.92% (8 cases), respectively, the difference was not statistically significance (χ2=0.01, P = 0.907); KPS score of laparoscopy group in 7 days after surgery were higher than laparotomy group [(79.33 ± 15.54) vs (73.49 ± 13.37), t = 2.84, P = 0.005], and in 30 days after surgery showed no statistical differences.?Conclusion?The clinical effect of 1aparoscopy-assisted distal gastrectomy for advanced gastric cancer is equivalent to the laparotomy, while with less trauma. Short-term quality of life in 1aparoscopy group is higher than laparotomy group.