目的:探讨腹腔镜下或常规开腹行胃癌D2根治术治疗局部进展期胃癌的临床疗效及3年生存情况.方法:选取2014年4月~2017年11月期间我院收治的局部进展期胃癌患者68例进行回顾性分析,根据不同的手术方法分为观察组和对照组,每组34例.观察组患者采用腹腔镜远端胃癌D2根治术治疗;对照组患者采用常规开腹远端胃癌D2根治术治疗.观察并比较两组患者治疗后的手术情况、术后恢复情况、近期治疗效果、并发症发生率及3年生存情况.结果:治疗后观察组在术中出血量、术中输血率、手术切口长度、肛门排气时间、下床活动时间、进流质饮食时间及住院时间方面均明显优于对照组,以上差异均有统计学意义.两组近期治疗效果指标清扫淋巴结数、肿瘤近端切缘和肿瘤远端切缘比较差异无统计学意义.观察组患者治疗后并发症的发生率显著低于对照组,差异有统计学意义.两组患者3年生存率比较无统计学意义.结论:与常规开腹胃癌D2根治术相比,对局部进展期远端胃癌患者腹腔镜下行D2根治术的临床疗效好,患者术中损伤小,术后恢复快,并发症发生率低,而且3年生存率无明显差异,值得在临床上进一步推广应用.%Objective To explore the clinical effect of laparoscopic or conventional laparotomy on the treatment of gastric cancer in the treatment of local advanced stage gastric cancer. Methods Choose between April 2014 and November 2017, our hospital during the period of 68 patients with locally advanced gastric cancer were retrospectively analyzed, according to the different operation methods were divided into observation group and control group, 34 cases in each group. The patients in the observation group were treated with the laparoscopic distal gastric cancer. The patients in the control group were treated with D2 radical treatment with distal gastric cancer. The postoperative operative conditions, postoperative recovery, recent treatment ef-fect, complication rate and 3 years of survival were compared and compared between the two groups. Results Observation group after treatment in the intraoperative blood loss, intraoperative blood transfusion rate, incision length, anal exhaust time, ambu-lation time, into the liquid diet time and hospital stay were significantly better than that in control group, the above differences were statistically significant. There was no statistically significant difference between the two groups in the recent treatment effect index clearing the number of lymph nodes, the proximal cut of the tumor and the distal edge of the tumor. The incidence of complications after treatment was significantly lower than that in the control group, and the difference was statistically signifi-cant. The 3-year survival rate of the two groups was not statistically significant. Conclusion Compared with D2 gastric cancer radical conventional laparotomy, laparoscopic downward in patients with locally advanced stage of distal gastric cancer clinical curative effect is good, D2 radical intraoperatie injury in patients with small, fast recovery, low complication rate, and no differ-ence between the 3 year survival rate, worthy of further popularization and application in clinic.
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