中国实用外科杂志

中国实用外科杂志

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进展期胃癌行腹腔镜与开腹D2淋巴结清扫术近期疗效对比分析

李    平，黄昌明，郑朝辉，谢建伟，王家镔，林建贤，陆    俊   

  1. 福建医科大学附属协和医院胃外科,福建福州 350001
  • 发布日期:2013-11-28

  • Published:2013-11-28

摘要：

目的    分析腹腔镜辅助胃癌D2淋巴结清扫术在进展期胃癌中应用的可行性及近期疗效。方法    对2010年1月至2011年12月期间在福建医科大学附属协和医院施行胃癌D2淋巴结清扫术的进展期胃癌病人，以性别、年龄、胃切除方式和浸润深度为指标，采用逐一配对法进行配对，最终296例病人纳入研究。其中,行腹腔镜手术148例（称腹腔镜组），行开腹手术148例（称开腹组）。比较两组病人的术中、术后情况及术后生存曲线的差异。结果    腹腔镜组首次下床活动时间、术后肛门排气时间和进食流质时间与开腹组相似，而手术时间、术中出血量、术中输血例数、进食半流质时间和术后住院时间等均少于开腹组（P＜0.05）。腹腔镜组术后并发症发生率为10.8%，明显低于开腹组的20.9%（P＜0.05）。腹腔镜组与开腹组平均淋巴结清扫数目分别为（33.0±10.6）枚和（31.0±8.0）枚，差异无统计学意义（P＞0.05）；按胃切除方式分层分析，腹腔镜组行远端胃大部切除术的No.6淋巴结平均清扫数目显著多于开腹组（P＜0.05）。其余各组别淋巴结平均清扫数目，无论是远端胃大部切除术还是全胃切除术差异均无统计学意义（P＞0.05）。腹腔镜组与开腹组术后1年存活率分别为80.4%和77.7%，其生存曲线差异亦无统计学意义（P＞0.05）。结论    腹腔镜辅助胃癌D2淋巴结清扫术治疗进展期胃癌具有安全、术后恢复快等优点，近期疗效与开腹手术相当。

关键词: 胃肿瘤, 胃切除术, 腹腔镜, 淋巴结清扫

Abstract:

Comparison of short-term efficacy of laparoscopy-assisted and open gastrectomy with D2 lymph node dissection for advanced gastric cancer        LI Ping,HUANG Chang-Ming,ZHENG Chao-Hui,et a1.Department of  Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
Correspondence author: HUANG Chang-ming, E-mail: hcmlr2002@163.com
Abstract    Objective    The aim of this study is to evaluate the technical feasibility, safety, and short-term efficacy of laparoscopy-assisted gastrectomy (LAG) for advanced gastric cancer (AGC). Methods    A retrospective case-control study was performed comparing LAG and OG for AGC. 148 patients with AGC underwent LAG between January 2010 and December 2011 were enrolled and these patients were compared with 148 AGC patients underwent OG during the same period. The comparison was based on the operative and postoperative measures, and follow-up results. Results  The first ambulation time, time to ?rst ?atus and time of resume fluids did not differ between the two groups(P＞0.05), while the operation time, the blood loss, transfused patient number, time of resume soft diet, and post-operative stay were significantly less in LAG group than those in OG group (P＜0.05). The postoperative complication rate of LAG group was significantly lower than OG group (P＜0.05). The mean number of resected lymph nodes (LNS) between the LAG group and OG group was similar (33.0±10.6 vs. 31.0±8.0). Furthermore, the mean number of removed LNS in each station was not significantly different in the distal gastrectomy and total gastrectomy (P＞0.05) except the No.6 station LN dissection in the distal gastrectomy of LAG (P<0.05). No statistical difference was seen in 1 year survival rate (80.4%vs. 77.7% P＞0.05) and the survival curve after surgery between the LAG group and OG group. Conclusion  Laparoscopy-assisted D2 radical gastrectomy is feasible, effective and has comparative short-term efficacy compared with open gastrectomy for advanced gastric cancer.

Key words: stomach neoplasms, gastrectomy, laparoscopy, lymphadenectomy