腹腔镜辅助与开腹D2胃癌根治术对进展期胃癌治疗效果的前瞻性研究  

Laparoscopic-assisted versus open D2 gastrectomy for advanced gastric cancer:a prospective study

作　　者：刘俊英[1] 刘腾[2] 王超[2] 刘少壮[2] 郭敏[2] LIU Jun-ying;LIU Teng;WANG Chao(Department of Operating Room,Qilu Hospital of Shandong University,Jinan 250012,China;Department of Gastrointestinal Surgery,Qilu Hospital of Shandong University)

机构地区：[1]山东大学齐鲁医院手术室,山东济南250012 [2]山东大学齐鲁医院胃肠外科

出　　处：《腹腔镜外科杂志》2021年第3期200-205,共6页Journal of Laparoscopic Surgery

摘　　要：目的:探讨腹腔镜辅助D2胃癌根治术治疗进展期胃癌的可行性、有效性及手术效果。方法:纳入2016年4月至2018年12月收治的T_(2~4a)N_(0~3)M_(0)期胃癌患者,215例行腹腔镜辅助D2胃癌根治术(观察组),337例行开腹D2胃切除术(对照组)。主要结局指标为短期手术结果、化疗情况,次要结局指标包括术后疼痛、焦虑。结果:两组患者检出淋巴结数量[(27.42±6.43)vs.(28.36±5.44),P>0.05]、术后并发症发生率(18.14%vs.19.29%,P>0.05)差异无统计学意义。观察组与对照组接受辅助化疗的患者比例为80.2%与76.6%,差异亦无统计学意义(P>0.05)。观察组辅助化疗时间的间隔[(35.62±14.36)d vs.(41.81±19.32)d,P<0.001]较短,术后早期恢复优于对照组。结论:在经验丰富的医院采取腹腔镜辅助D2胃癌根治术治疗进展期胃癌是可行的,术后患者可更早地开始辅助化疗,康复更快,并可尽快缓解术后疼痛,术后焦虑水平亦较低。Objective:To study the feasibility,effectiveness and surgical effect of laparoscopic-assisted D2 gastrectomy(LAD2G)for advanced gastric cancer.Methods:Between Apr.2016 and Dec.2018,patients with clinical stage T_(2-4a)N_(0-3)M_(0) gastric cancer were enrolled and assigned to either LAD2G group(n=215)or open D2 gastrectomy(OD2G)group(n=337).The primary endpoint was short-term surgical and chemotherapy outcomes.The postoperative pain and anxiety were compared as the secondary endpoint.Results:The two groups showed similar number of retrieved lymph nodes[(27.42±6.43)vs.(28.36±5.44),P>0.05]and postoperative complication incidence(18.14%vs.19.29%,P>0.05).80.2% of patients in LAD2G group and 76.6% in OD2G group received adjuvant chemotherapy(P>0.05).The mean time interval to adjuvant chemotherapy was shorter in LAD2G group[(35.62±14.36)d vs.(41.81±19.32)d,P<0.001].Furthermore,LAD2G was superior to OD2G in terms of earlier postoperative recovery.Conclusions:LAD2G is feasible for advanced gastric cancer in experienced centers.Patients after LAD2G tend to have earlier initiate of adjuvant chemotherapy.LAD2G could provide more rapid postoperative recovery and relief of postoperative pain,along with lower postoperative anxiety.

关 键 词：胃肿瘤 胃癌根治术 D2淋巴结清扫术 腹腔镜检查 剖腹术 

分 类 号：R735.2[医药卫生—肿瘤]