目的 探讨腹腔镜辅助远端胃癌D2根治术的疗效及安全性.方法 选择2009年1月—2011年12月在海南医学院第二附属医院肿瘤外科行远端胃癌D2根治术的患者184例,按照手术方式的不同分为传统开腹组与腹腔镜组,传统开腹组83例,腹腔镜组101例,传统开腹组患者采用传统开腹行远端胃癌D2根治术,腹腔镜组患者使用腹腔镜辅助远端胃癌D2根治术,对术中、术后相关指标,术后生活质量(karnofsky)评分及生存时间进行对比.结果 腹腔镜组患者的手术时间长于传统开腹组,手术切口长度、手术失血量少于传统开腹组(t=8.354、46.236、54.467,P<0.01),2组清扫淋巴结数量、近切端距肿瘤距离和远切端距肿瘤距离比较差异无统计学意义(t=1.685、1.467、0.397,P>0.05);腹腔镜组患者术后排气时间、下床活动时间、镇痛药使用次数、流食进食时间和住院时间等均短/少于传统开腹组,差异具有统计学意义(t=16.171,12.508,15.521,9.657,12.239,P<0.01);2组患者的各项并发症、生存时间差异均不具有统计学意义(P均>0.05);腹腔镜组患者在手术后5d的Karnofsky评分高于传统开腹组,差异具有统计学意义(t=6.906,P<0.05),术后30d的Karnofsky评分比较差异无统计学意义(t=0.725,P>0.05).结论 利用腹腔镜辅助进行远端进展期胃癌D2根治术,与开腹手术的近期效果及远期效果大体相当,但是利用腹腔镜进行操作,对患者造成的创伤较小,患者恢复速度快,安全性较好.%Objective To explore the efficacy and safety of laparoscopic assisted radical gastrectomy for distal radical radiotherapy.Methods From January 2009 to December 2011,184 patients in our hospital for radical cancer radical surgery were enrolled,according to the different surgical methods, they were divided into control group and observation group, the control group of 83 cases,observation group of 101 cases,the patients in the control group were treated with traditional open surgery,patients in the observation group were treated with laparoscopic assisted radical gastrectomy for distal gastric cancer, the effect of treatment was compared.Results The operation time of laparoscopic group was longer than that of traditional lapa -rotomy group,and the length of incision and the amount of blood loss were less than those of traditional laparotomy group(t=8.354,t=46.236, t=54.467, P<0.05).There was no significant difference between the two groups in the number of lymph nodes,the distance from the proximal end to the tumor and the distance from the far end to the tumor(t=1.685,t=1.467,t=0.397,P>0.05).The laparoscopic group of patients with postoperative exhaust time,ambulation time,analge-sic use,number of liquid feeding time and hospitalization time were shorter than that of the conventional laparotomy group,the difference was statistically significant(t=16.171,t=12.508,t=15.521,t=9.657,t=12.239,P<0.05).There was no significant difference in the complications and the 5 year survival rate between the two groups(χ2=0.171,χ2=0.572,χ2=1.475,χ2=1.164,χ2=0.826,χ2=0.460, χ2=1.160, P>0.05).The Karnofsky score of the laparoscopic group was higher than that of the traditional laparotomy group on the 5 day after operation,the difference was statistically significant(t=6.906,P<0.05).30 days after surgery,the difference of Karnofsky score between the two groups was not statistically signif-icant(t=0.725,P>0.05).Conclusion The short term effect and long term effect of laparoscopic assisted radical resection of distal gastric cancer D2 is similar to open surgery for radical resection of distal gastric cancer D 2,but the use of laparoscopic operation in patients with less trauma,quick recovery,good safety,it is worthy of promotion in the clinical range.
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