腹腔镜辅助与开腹手术治疗进展期胃癌的疗效对比  

A follow-up study on laparoscopy-assisted and open gastrectomy for advanced gastric cancer

作　　者：华瑾[1] 杜建军[2] 王安辉[1] 李纪鹏[3] 赵青川[3] 方诚[3] 闫永平[1] 

机构地区：[1]第四军医大学军事预防医学系流行病学教研室,西安710032 [2]复旦大学附属华山医院普外科 [3]第四军医大学西京消化病医院消化外科

出　　处：《中华普通外科杂志》2014年第6期421-424,共4页Chinese Journal of General Surgery

摘　　要：目的 探讨进展期胃癌腹腔镜辅助D2根治术的安全性和可行性.方法 选择第四军医大学西京消化病医院2005年9月至2009年12月240例胃癌患者为研究对象,其中120例进展期胃癌接受腹腔镜辅助D2根治手术（腹腔镜组）,120例进展期胃癌接受常规开腹D2根治手术（开腹组）为对照组,各组远端胃切除、全胃切除均分别为50例及70例.对患者的手术时间、术中出血量、淋巴结切除数量、肿瘤切缘情况、手术并发症、5年肿瘤复发情况、5年无病生存率进行对比分析.结果 120例腹腔镜组患者中均无中转开腹,平均手术时间（307±84） min,明显长于开腹组的（203±52） min（t＇=11.556,P＜0.01）;腹腔镜组术中出血量（258±78） ml,明显少于开腹组的（318±89） ml（=5.550,P＜0.01）;腹腔镜组获取淋巴结数（17±11）枚,开腹组获取淋巴结数（16±10）枚,两组间差异无统计学意义（t =0.723,P＞0.05）.腹腔镜组与开腹组所有切除标本切缘均阴性、无肿瘤细胞残留.腹腔镜组有9例患者发生手术相关并发症,发生率为7.5％,开腹组8例,发生率为6.7％,两组间差异无统计学意义（x2=0.252,P＞0.05）.腹腔镜组术后住院（10.6±4.7）d,明显少于开腹组的（14.3±2.9） d（t＇=7.339,P＜0.01）.两组住院期间均无死亡发生.中位随访期47个月,腹腔镜组与开腹组的5年无病生存率分别是47.6％和42.8％（x2=0.577,P＞0.05）. 结论 腹腔镜辅助进展期胃癌根治手术是一种安全、可行的手术治疗方法.Objective This study was to compare surgical safety and oncologic adequacy of laparoscopy-assisted gastrectomy （LAG） versus open gastrectomy （OG） for advanced gastric cancer.Methods 120 consecutive AGC patients undergoing LAG with D2 lymph node dissection between September 2005 to December 2009 were compared with 120 AGC patients undergoing OG during the same period.In each group,50 underwent distal gastrectomy,70 for total gastrectomy.Results There was no conversion to open surgery in LAG.The operative time was significantly longer in LAG than OG [（307 ± 84） min vs.（203 ± 52） min,t＇=11.556,P ＜ 0.01].The estimated blood loss was significantly less in LAG group than OG group [（258 ± 78） ml vs.（318 ± 89） ml,t =5.550,P ＜ 0.01].The number of lymph nodes retrieved was（17 ±11） in LAG,（16 ±10）in OG （t =0.723,P＞0.05）.All margins were tumor free in both groups.9 patients had the postoperative complication in LAG,8 patients in OG （P ＞ 0.05）.Length of postoperative stay was significantly shorter in LAG than OG [（10.6 ＋ 4.7） vs.（14.3 ± 2.9） days,t＇ =7.339,P ＜0.01].There was no mortality in both groups.The 5-year recurrence-free survival rate were comparable （47.6％ in LAG vs.42.8％ in OG,x2 =0.577,P ＞ 0.05） between the two groups.Conclusions This study suggested that laparoscopy-assisted gastrectomy is safe and feasible in terms of surgical outcome and oncologic adequacy for advanced gastric cancer.

关 键 词：胃肿瘤 腹腔镜 胃切除术 

分 类 号：R735.2[医药卫生—肿瘤]