腹腔镜与开腹全胃切除联合D2淋巴结清扫术治疗进展期胃癌的疗效比较

摘要

目的：：比较腹腔镜与开腹全胃切除术联合D2淋巴结清扫术治疗进展期胃癌的临床疗效。方法：回顾分析2009年5月至2011年5月全胃切除联合D2淋巴结清扫术治疗196例进展期胃癌患者的临床资料，将患者分为腔镜组( n=72)与开腹组(n=124)，腔镜组行腹腔镜下全胃切除联合D2淋巴结清扫术，开腹组行开腹全胃切除联合D2淋巴结清扫术，比较两组患者临床指标、并发症发生情况及远期生存率。结果：腔镜组手术时间较开腹组显著延长(P<0.05)，术中出血量、术后首次排气时间、术后胃肠道功能恢复时间及住院时间等显著优于开腹组(P<0.05)，两组术中淋巴结检出数量、肿瘤远近端切缘长度及住院费用差异无统计学意义(P>0.05)。腔镜组术后并发症发生率为2.8%，显著低于开腹组的12.9%，差异有统计学意义(P<0.05)。两组患者在术后1年、3年、5年的无瘤生存率、总生存率差异无统计学意义(P>0.05)。结论：腹腔镜全胃切除联合D2淋巴结清扫术治疗进展期胃癌具有术后康复快、并发症少等优点，且淋巴结清扫数量、术后远期生存率与开腹手术相当。%Objective:To compare the clinical efficacy between laparoscopic and open total gastrectomy combined with D2 lymph node dissection for patients with advanced gastric carcinoma. Methods:Clinical data of 196 patients with advanced gastric carci-noma treated by total gastrectomy combined with D2 lymph node dissection from May 2009 to May 2011 were retrospectively analyzed. They were divided into laparoscopic group (n=72) and open group (n=124),laparoscopic group underwent laparoscopic total gastrec-tomy combined with D2 lymph node dissection and open group underwent open total gastrectomy combined with D2 lymph node dissec-tion. The clinical index,complications and long-term survival rate of the two groups were compared. Results:The operative time in lapa-roscopic group was significantly longer than that in open group (P<0. 05),and the intraoperative blood loss,first exhaust time,recovery time of gastrointestinal function and hospitalization time in laparoscopic group were significantly less than those in open group ( P<0. 05). No statistically significant differences in the number of lymph nodes,tumor proximal and distal margin and hospitalization cost be-tween two groups were found. The postoperative complication rate in laparoscopic group was 2. 8%,which was lower than that in open group (12. 9%,P<0. 05). There were no significant differences in tumor free survival rate and overall survival rate after 1 year,3 years and 5 years between the two groups (P>0. 05). Conclusions:Compared with open surgery,laparoscopic total gastrectomy combined with D2 lymph node dissection for patients with advanced gastric carcinoma has characteristics of faster recovery,fewer complications, and no statistically significant difference in the number of harvested lymph nodes and long-term survival rate.