进展期远端胃癌腹腔镜辅助与开腹根治术的对比研究  

Comparative study of laparoscopy-assisted and laparotomy radical surgery in progressive stage of distal gastric cancer

作　　者：罗运生[1] 夏涛[1] 李威[1] 

机构地区：[1]广西壮族自治区柳州市人民医院胃肠外科,广西柳州545006

出　　处：《中国医药科学》2014年第24期10-13,共4页China Medicine And Pharmacy

基　　金：广西壮族自治区卫生厅立项课题(Z2012583)

摘　　要：目的：探讨腹腔镜辅助进展期远端胃癌根治术的可行性、安全性及近期疗效。方法对比分析2012年1月～2013年11月行腹腔镜辅助和开腹Ⅱ、Ⅲ期远端胃癌D2根治术患者的临床资料，其中腹腔镜组45例，开腹组45例作为对照。结果腹腔镜组淋巴结清扫数目（23.2±7.0）枚、远切缘距肿瘤边缘（6.2±1.1）c m、近切缘距肿瘤边缘（8.5±1.2）cm与开腹组（24.3±7.6）枚、（6.4±1.3）cm、（8.0±1.5）cm差异均无统计学意义（P＞0.05），术后病理远近切缘均无癌残留。腹腔镜组手术时间比开腹组长[（205.0±36.8）min比（188.0±41.0）min，P=0.042]。腹腔镜组切口长度明显缩短[（6.4±0.8）cm比（19.5±1.7）cm，P=0.000]，术中出血量明显减少[（110.6±72.6）mL比（256.1±122.2）mL，P=0.000]，术后腹部切口疼痛时间明显缩短[（3.0±0.9）d比（4.6±1.0）d，P=0.000]，术后下床活动时间更早[（3.8±1.0）d比（5.2±1.2）d，P=0.000]，术后肛门排气时间更早[（3.0±0.9）d比（4.8±1.8）d，P=0.000]，术后住院时间缩短[（11.7±3.1）d比（14.1±3.3）d，P=0.001]，两组手术并发症发生率[6.7％（3/45）比11.1％（5/45），P=0.711]差异无统计学意义。结论腹腔镜辅助进展期远端胃癌根治术能达到开腹手术胃癌D2根治效果，安全可行，切口短，出血少，术后恢复快，微创效果较好。Objective To study the feasibility, the safety and the short term effect of laparoscopy-assisted in progressive stage of distal gastric cancer. Methods To comparatively analyze the clinical cases, who were treated with laparoscopy-assisted and laparotomy radical surgery in stage Ⅱ and stage Ⅲ of distal gastric cancer, and were divided into laparoscopy group and laparotomy surgery group, with 45 patients in each group. Results The number of lymph nodes removed, the distance between distal incisal margin and tumor border, the distance between proximal incisal margin and tumor border were（23.2±7.0）, （6.2±1.1）cm, and （8.5±1.2）cm in laparoscopy group, while which were（24.3±7.6）, （6.4±1.3）cm,and （8.0±1.5）cm in laparotomy surgery group, there were no statistical significance （P 〉 0.05） and had no cancer residual. The operation time[（205.0±36.8）min vs （188.0±41.0）min, P=0.042]was higher, the incision length[（6.4±0.8）cm vs （19.5±1.7）cm, P=0.000] was shorter, the intraoperative blood loss[（110.6±72.6）mL vs （256.1±122.2）mL, P=0.000] was lesser, the pain time of postoperative wound[（3.0±0.9） d vs （4.6±1.0）d,P=0.000], the postoperative activity out of bed days[（3.8±1.0）d vs （5.2±1.2）d, P=0.000], the postoperative exhaust time[（3.0±0.9）d vs （4.8±1.8）d, P=0.000], the postoperative hospital stay[（11.7±3.1）d vs （14.1±3.3）d, P=0.001] were shorter in laparoscopy group compared with laparotomy surgery group. The postoperative complication rate[6.7%（3/45） vs 11.1%（5/45）, P=0.711] were not significantly different between the two groups（all P〉0.05）. Conclusion Laparoscopy-assisted in progressive stage of distal gastric cancer could achieve the treatment effect of radical operation of gastric cancer（D2）, is feasible, safe and faster of postoperative recovery, and has better effect of minimally invasive.

关 键 词：胃肿瘤 外科学 胃癌根治术 腹腔镜 

分 类 号：R735.2[医药卫生—肿瘤]