目的：通过比较腹腔镜辅助下行近端胃癌术式与传统开腹近端胃癌术式的疗效，探讨临床治疗胃癌的最佳手术方式。方法将58例胃癌患者根据患者自身情况和临床医生建议，分为观察组（腹腔镜下近端胃癌根治术）和对照组（传统开腹近端胃癌根治术），每组各29例。记录并分析患者术后恢复情况和术后并发症比例，并进行统计学比较。结果所有患者手术均顺利完成，无死亡病例。观察组所需手术时间较长，但术中出血量较少，住院天数少，首次排气和进食时间较短，与对照组比较，差异均具有统计学意义（P均＜0．05）。2组清扫淋巴结数目无统计学差异（P＞0．05）。对照组和观察组患者术后CD4＋T细胞比例、CD4＋／CD8＋T细胞比例均有不同程度下降，差异均具有统计学意义（ P均＜0．05），但CD8＋T细胞比例并未有统计学差异（P＞0．05）。对照组术后并发症发生率高于观察组，但差异无统计学意义（P均＞0．05）。结论腹腔镜术式可降低术中出血量，且可以完全清扫淋巴结，对免疫系统影响较小，有利于患者术后早日恢复，应在临床使用中大范围推广。%Objective To study the clinical efficacy of laparoscopic surgery and conventional open proximal surgery for gastric cancer and the best surgical method .Methods 58 cases of gastric cancer , according to the patient's own situation and doctor suggestion ,were divided into the observation group ( laparoscopic surgery ) and the control group ( conventional open proxi-mal surgery),29 cases in each.The postoperative recovery and complications of patients were compared .Results The operations in both groups were successful without death .The operational time required of the observation group was longer ,but bleeding vol-ume during operation and hospitalization days were less ,and the time needed by first exhaust and eating were shorter compared with the control group,there had statistically significant difference (all P<0.05).Dissected lymph nodes of the 2 groups had no statistical difference(P>0.05).The proportion of CD4+T cells,CD8+T cells,CD4+/CD8+T cell ratio were differently de-creased after operation in both groups ,there had significant difference (P<0.05),while the proportion of CD8+T cells had no significant difference(P>0.05).The complication rate in the control group was higher than that of the observation group ,and the differences were not statistically significant (all P>0.05).Conclusion Laparoscopic surgery can decrease bleeding volume dur-ing operation,with complete lymph node dissection ,has less impact on the immune system ,and it should be widely spread in clin-ic.
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