腹腔镜辅助胃癌根治术的近期和远期疗效  

A retrospective study comparing perioperative results and long-term survival between laparoscopy-assisted gastrectomy and open procedures for gastric cancer

作　　者：陈钶[1] 牟一平[1] 吴迪[1] 潘宇[1] 徐晓武[1] 张人超[1] 蔡佳沁[1] 

机构地区：[1]浙江大学医学院附属邵逸夫医院普外科,杭州310016

出　　处：《中华普通外科杂志》2014年第2期81-84,共4页Chinese Journal of General Surgery

基　　金：浙江省重大科技专项资助项目（2011C13036-2）

摘　　要：目的 评估腹腔镜辅助胃癌根治术的近期及远期疗效.方法 选取浙江大学附属邵逸夫医院普外科2004年10月至2008年3月间行胃癌根治术的病例,根据患者的性别、年龄、胃切除范围、肿瘤分化及TNM分期为指标,按照1∶1病例配对的方式分为腹腔镜辅助胃癌根治术组（LAG组）和开腹胃癌根治术组（OG组）各85例,比较2组患者的手术时间、术中失血量、术后恢复情况、并发症、术后病理及远期随访结果.结果 相比于OG组,LAG组手术时间长[（277±62） min比（211±46） min,t=7.882,P＜0.05）],但术中出血少[（161±90） ml比（267±141）ml,t=-5.854,P＜ 0.05]；LAG组患者术后肛门排气时间[（3.7±1.3）d比（4.2±1.1 d）,t=-2.318]、住院时间[（10±3）d比（12±6）d]均短于OG组（t=-2.325,P ＜0.05）.2组之间淋巴结清扫数目、术后总体并发症发生率相比差异无统计学意义（P＞0.05）.LAG组和OG组5年无瘤生存率、总生存率分别为76％、78％和75％、73％,差异无统计学意义（P＞0.05）；将2组病例按肿瘤TNM分期分层后分别作对比,则相同分期下2组之间生存率相比差异仍无统计学意义（P＞0.05）.结论 腹腔镜辅助胃癌根治术微创效果明显,术后恢复快,与开腹手术相比并不会增加患者术后远期复发和死亡的风险.Objective To evaluate the short-and long-term outcomes of laparoscopy-assisted gastrectomy （LAG） for gastric cancer.Methods After studying the patients＆#39; demographic data,extent of gastrectomy and lymphadenectomy,as well as differentiation and tumor TNM stage,85 patients who underwent LAG were individually matched to 85 patients who underwent open surgery （OG） between October 2004 and March 2008.The operative time,intraoperative blood loss,postoperative recovery,complications,pathological findings,and follow-up data were compared between the two groups.Results The mean operative time was significantly longer in the LAG group than in the OG group （277 ± 62） min vs.（211 ±46） min,t =7.882,P 〈0.05,whereas intraoperative blood loss was significantly lower （161 ±90） ml vs.（267 ± 141） ml,t =-5.854,P 〈0.05.In addition,there was a significant reduction in the time to first flatus and postoperative hospital stay （3.7 ± 1.3） days vs.（4.2 ± 1.1） days and （10 ± 3） days vs.（12 ± 6） days,respectively t =-2.318,-2.325,P 〈 0.05.There was no significant difference between the LAG group and OG group with regard to the number of harvested lymph nodes and overall postoperative complications.The 5-year disease-free survival rates and overall survival rates were 76%,78%,respectively,in LAG group and 75%,73%,respectively in OG group （all P 〉 0.05）.Conclusions LAG is suitable and minimally invasive for treating gastric cancer.Compared to OG,the LAG will not increase the risk of recurrence and mortality after surgery.

关 键 词：胃肿瘤 胃切除术 腹腔镜 

分 类 号：R735.2[医药卫生—肿瘤]