胃癌腹腔镜辅助手术与开腹手术的单中心回顾性对照研究  

A single center retrospective comparative study of laparoscopy assisted surgery and laparotomy for gastric cancer

作　　者：周宏 夏加增 陈义钢 ZHOU Hong;XIA Jiazeng;CHEN Yigang(Department of General Surgery,Wuxi Second Hospital Affiliat-ed to Nanjing Medical University,Wuxi 214002,China)

机构地区：[1]南京医科大学附属无锡第二医院普外科,江苏无锡214002

出　　处：《实用医学杂志》2018年第19期3255-3259,共5页The Journal of Practical Medicine

基　　金：无锡市科技局课题(编号:CSE31N1707)

摘　　要：目的比较胃癌腹腔镜辅助手术与开腹手术的临床效果。方法收集2010年1月至2012年12月期间在无锡市第二人民医院普外科手术治疗的胃癌患者的临床病理资料,有5年随防资料的患者共有147例,其中行开腹胃癌根治术的患者有71例,腹腔镜辅助胃癌根治术的患者有76例。对上述患者的临床病理及生存数据进行统计分析。结果胃癌腹腔镜辅助手术的总淋巴结清扫数量大于胃癌开腹手术组(23.63±10.290 vs. 19.31±7.080,P=0.004),但两组在阳性淋巴结数量上差异没有统计学意义(2.523 7±4.269 vs. 2.560±3.637,P=0.950)。腹腔镜辅助手术组的手术时间与开腹手术组无明显统计学差异(3.07±0.662)h vs.(2.9±0.485)h,P=0.064,但腹腔镜辅助手术组的术中出血量明显少于开腹组(121.05±58.853)mL vs.(286.34±134.942)mL,P=0.000。腹腔镜辅助手术组的术后并发症发生例数(6例)明显低于开腹组的15例并发症发生数(P=0.022)。腹腔镜组的5年生存率为52.6%,开腹手术的5年生存率为47.9%,两者在5年生存率上没有明显统计学差异(P=0.328)。腹腔镜辅助手术组的平均费用为(34 905.61±3 877.46)元,大于开腹组的(32 010.55±4 871.58)元,两者相比差异有统计学意义(P=0.000)。对进展期胃癌的亚组分析显示,腹腔镜手术组的总淋巴结清扫数量大于开腹组,腹腔镜组手术中出血量明显少于开腹组,差异有统计学意义(P <0.05)。两者在手术时间、阳性淋巴结数、术后并发症、5年生存率上差异无统计学意义(P> 0.05)。结论胃癌腹腔镜辅助手术有助于减少术中出血和术后并发症,但腹腔镜手术的费用高于开腹手术。腹腔镜辅助手术与开腹手术的5年生存率没有显著差异。Objective To compare the clinical results of laparoscopy assisted surgery and open surgery for gastric cancer.Methods We collected the clinicopathological data of patients with gastric cancer who underwent surgical treatment in Department of general surgery,Wuxi Second People's Hospital from January 2010 to Decem-ber 2012.The clinicopathological and survival data of the above patients were statistically analyzed.Results The total lymph node dissection of laparoscopic assisted surgery for gastric cancer was larger than that of open surgery group(23.63±10.290 vs.19.31±7.080,P=0.004),but there was no significant difference in the number of pos-itive lymph nodes between the two groups(2.523 7±4.269 vs.2.560±3.637,P=0.950).There were no signifi-cant difference for operation time between laparoscopic assisted surgery group and open surgery group(3.07±0.662 vs.2.9±0.485,P=0.064),but for blood loss,laparoscopic group of intraoperative was significantly less than the open surgery(121.05±58.853 mL vs.286.34±134.942 mL,P=0.000).The number of postoperative complications(6 cases)in the laparoscopic assisted operation group(6 cases)was significantly lower than that of the 15 cases in the laparotomy group(P=0.022).The 5 year survival rate of the laparoscopy group was 52.6%and the open surgery group was 47.9%.There was no significant difference between the two groups in the 5 year survival rate(P=0.328).The average cost of the laparoscope assisted operation group was more expensive than the open surgery group(34 905.61±3 877.46 yuan vs.32 010.55±4 871.58 yuan,P=0.000).Subgroup analysis of advanced gastric cancer showed that the number of total lymph node dissection in laparoscopic surgery group was larger than that in laparotomy group,and the amount of bleeding in laparoscopic group was significantly less than that in laparotomy group(P<0.05).There was no significant difference in the operation time,the number of positive lymph nodes,the postoperative complications and the 5 year survival rate(P>0.05).Conclusion laparo

关 键 词：胃癌 腹腔镜 对照研究 

分 类 号：R735.2[医药卫生—肿瘤]