腹腔镜下胃癌D2 淋巴结清扫的临床疗效及中期随访报告

Medium-term follow-up of laparoscopic surgery on radical gastrectomy with D2 dissection for gastric cancer

摘要:

目的 比较腹腔镜胃癌D2 根治术与开腹手术的疗效，探讨腹腔镜胃癌D2 根治术的可行性。 方法 选取浙江省瑞安市人民医院2008 年10 月-2013 年8 月收治的胃癌患者，根据患者采取的手术方式不 同分为两组，其中175 例腹腔镜手术患者纳入腹腔镜组，163 例开腹手术患者纳入开腹组。比较两组患者的术 中及术后情况、淋巴结清扫数目、并发症及肿瘤根治程度等。结果 腹腔镜组清扫淋巴结（26.3±13.9）枚， 开腹组清扫淋巴结（26.8±10.2）枚，差异无统计学意义（t =-0.40，P =0.684）。腹腔镜组术中出血情况以及 术后排气时间均优于开腹组。腹腔镜组患者术后住院时间小于开腹组，组间比较差异有统计学意义（P <0.05）。 腹腔镜组的3 年生存率为92.00%，与开腹组92.63% 相比较，差异无统计学意义（χ2=1.54，P =0.262）。 结论 腹腔镜胃癌D2 根治术具有安全、术后恢复快和创伤小等优点，同时能够达到与开腹组相近的淋巴结 清扫效果。

Abstract:

Objective To explore the feasibility and clinical outcome of laparoscopy-assisted gastrectomy with D2 dissection by comparing the efficacy of open surgery on radical gastrectomy with D2 dissection for gastric cancer patients. Methods The patients with gastric cancer from October 2008 to August 2013 were divided into two groups according to the different surgical methods. Among them, 175 patients underwent laparoscopic surgery (laparoscopy-assisted surgery group, Group L), and 163 patients underwent laparotomy surgery (open surgery group, Group O). The number of lymph nodes dissected, postoperative recovery, complications, mortality and survival rate of the two groups were compared and analyzed. Results There was no significant difference in the number of lymph nodes resect between the two groups [Group L and Group O: (26.3 ± 13.9) vs (26.8 ± 10.2), t = -0.40, P = 0.684]. Compared with open surgery, the laparoscopy-assisted surgery showed significantly less intraoperative blood loss and quicker recovery of gastrointestinal function. The postoperative hospitalization time of laparoscopic group was less than that of laparotomy group, the difference was statistically significant (P < 0.05). No significant difference was found in 3-year survival rate between the two groups (Group L vs Group O: 92.00% vs 92.63%, P = 0.262). Conclusions Compared to open surgery, laparoscopic gastrectomy is safer and has quicker postoperativerecovery. There is no statistical difference in the number of resect lymph nodes between lapamscopic and open gastrectomy.