腹腔镜辅助与开腹胃癌根治术围手术期疗效的对比研究

目的:对比分析腹腔镜辅助胃癌根治术与开腹胃癌根治术的术后早期疗效.方法:回顾分析2005年至2010年为21例患者行腹腔镜辅助胃癌根治术的临床资料(腹腔镜组,laparoscopic gastrectomy,LG组),以同期66例开腹胃癌根治术作为对照(开腹组,open gastrectomy,OG组);对比两组患者的...     

腹腔镜辅助胃癌根治术在老年胃癌患者中的应用分析

目的:探讨老年胃癌患者行腹腔镜辅助胃癌根治术的安全性及临床疗效。方法:2013年1月至2016年6月为104例老年(65岁)胃癌患者行胃癌D2根治术,其中56例行腹腔镜辅助胃癌根治术(腔镜组),48例行开腹胃癌根治术(开腹组)。比较两组术前合并症、术中情况及术后恢复情况,并对并发症的危险因素进行分析。结果:腔镜组术中出血量、术后首次排气时间、拔除引流管时间、拔胃管时间及术后住院时间均优于开腹组,差异有统计学意义(P0.05)。手术时间及术前合并症是术后并发症的独立危险因素。结论:老年人行腹腔镜辅助胃癌根治术能取得与开腹手术相同的根治效果,且具有明显的微创优势。     

腹腔镜辅助与开腹胃癌根治术治疗进展期胃癌中的效果比较

目的 比较腹腔镜与传统胃癌根治术在进展期胃癌中的效果.方法 分析我院从2007年6月至2009年5月开展的30例进展期胃癌行腹腔镜下辅助胃癌根治术病例资料,与同期30例进展期胃癌行开腹胃癌根治术病例资料作为对照,比较两组患者的手术指标、术后恢复及肿瘤根治程度.结果腹腔镜组手术时间显著长于开腹组(P<0.05),但止痛剂使用次数、出血量和输血率、手术切口长度、术后第1天白细胞数目、术后第1天体温升高程度、肠功能恢复时间及总住院时间均小于开腹组(P<0.05),而在切缘距肿瘤距离、淋巴结清扫数目及近期并发症上两组差异无统计学意义(P均>0.05).结论 腹腔镜下胃癌D2根治术应用于治疗进展期胃癌,安全、可行、有效、创伤小且近期效果良好.     

腹腔镜辅助胃癌根治术在老年人胃癌中的应用

目的 探讨腹腔镜辅助胃癌根治术在老年胃癌患者中应用的可行性及临床疗效.方法 2007年1月至2009年12月期间,福建医科大学附属协和医院胃外科对255例年龄在65岁以上的老年胃癌患者施行D2根治术,其中行腹腔镜辅助胃癌根治术患者（腹腔镜组）116例,行常规开腹手术患者（开腹组）139例.比较两组患者术中、术后恢复、并发症发生及术后生存情况,并对术后并发症的危险因素进行分析.结果 腹腔镜组术中出血量和术中输血例数均少于开腹组,术后排气时间、进食流质时间和住院时间均短于开腹组,差异均有统计学意义（P＜0.01）;而两组患者手术时间和淋巴结清扫数目的差异无统计学意义（均P＞0.05）.腹腔镜组术后并发症发生率为15.5％（18/116）,明显低于开腹组的28.1％（39/139）（P＜0.05）.是否行腹腔镜手术（P＜0.05）、手术时间（P＜0.01）和术前合并症（P＜0.01）是老年人胃癌术后并发症的独立危险因素;手术时间（P＜0.05）和术前合并症（P＜0.01）是老年人腹腔镜辅助胃癌根治术后并发症的独立危险因素.腹腔镜组和开腹组患者术后平均生存时间分别为23.0和22.5个月,差异无统计学意义（P＞0.05）.结论 老年人腹腔镜辅助胃癌根治术能够达到与开腹手术相同的根治效果,且具有明显的微创优势.手术时间和术前合并症是老年人腹腔镜胃癌根治术后并发症的独立危险因素.     

腔镜辅助与传统远端胃癌根治术的近期疗效观察

目的通过对比腹腔镜与传统开腹远端胃癌根治术的近期疗效,探讨腹腔镜辅助下胃癌根治术可行性、根治性与安全性。方法将40例行胃癌根治术患者按照治疗方式分为观察组(实施腹腔镜辅助远端胃癌根治术)17例和对照组(传统开腹远端胃癌根治术)23例,对比分析2组治疗效果与并发症发生情况。结果 2组手术时间相比,差异无统计学意义(P>0.05);2组淋巴结清扫数相比,差异无统计学意义(P>0.05);观察组出血量、术后排气时间及术后住院天数均明显少于对照组,2组相比差异有统计学意义(P<0.05)。观察组出现并发症1例,对照组1例,均经对症处理后症状缓解。结论腹腔镜辅助远端胃癌根治术与传统开腹远端胃癌根治术近期疗效相近,且具有创伤小、出血量小、恢复快、并发症少等优点。     

腹腔镜辅助进展期胃癌D2根治术与开腹手术近期疗效的临床对照研究

目的探讨腹腔镜辅助与传统开腹手术治疗进展期胃癌的近期疗效。方法对2010年10月至2012年10月期间因胃癌在笔者所在医院普外中心行腹腔镜辅助胃癌D2根治术（腹腔镜组,76例）和同期行传统开腹胃癌D2根治术（开腹组,104例）患者的临床资料进行回顾性分析,比较2组患者的手术相关指标、术后恢复情况和肿瘤根治程度。结果腹腔镜组的手术时间为（192．5±14．8）min,长于开腹组的（171．5±16．5）min（P〈0．05）;但腹腔镜组术中出血量、术后引流量、手术切口长度及住院时间则少于或短于开腹组（P〈0．05）。术后并发症发生率及肿瘤根治程度2组问的差异无统计学意义（P〉0．05）。2组均无切缘癌残留和手术死亡病例。结论腹腔镜辅助进展期胃癌D2根治术,能达到与开腹手术相当的临床近期疗效,且微创优势明显。     

腹腔镜胃癌D2根治术治疗进展期胃癌的疗效与安全性

目的比较腹腔镜与开腹胃癌D2根治术在进展期胃癌治疗中的疗效与安全性。方法回顾性收集笔者所在医院2011年3月至2014年3月期间收治的217例进展期胃癌患者的临床资料,根据术式将其分为腹腔镜组(103例,行腹腔镜胃癌D2根治术)与开腹组(114例,行开腹胃癌D2根治术),比较2组患者的手术效果相关指标。结果在术中指标方面,2组患者的手术时间、近端切缘距离、远端切缘距离及淋巴结清扫数目比较差异均无统计学意义(P>0.05),但腹腔镜组的术中出血量和切口长度少于(短于)开腹组(P<0.05)。在术后指标方面,腹腔镜组的术后排气时间、术后进食时间、自主下床活动时间、术后住院时间、镇痛药使用次数及术后总并发症发生率均短于(少于或低于)开腹组(P<0.05),而手术费用却高于开腹组(P<0.05),但2组患者的住院总费用、胃癌病死率和肿瘤复发/转移率比较差异均无统计学意义(P>0.05)。结论腹腔镜与开腹胃癌D2根治术治疗进展期胃癌的临床效果均较好,但与传统开腹胃癌D2根治术相比,腹腔镜胃癌D2根治术的创伤小、术后恢复快、并发症少、安全性高。     

腹腔镜辅助与开腹远端胃癌D2根治术近期康复的对比研究

目的 探讨腹腔镜辅助远端胃癌根治术患者术后早期的康复情况.方法 回顾性分析2010年1月至2012年12月56例腹腔镜辅助下远端胃癌根治术(腹腔镜组)与同期62例开腹远端胃癌根治术(开腹组)患者的临床资料.结果 两组手术时间、淋巴结清扫数目、pTNM分期、切除长度及术后并发症发生率等比较差异无统计学意义(P＞0.05).腹腔镜组术中出血量明显少于开腹组(120±25 ml VS 165±42 ml,P＜ 0.05),腹腔镜组术后胃肠功能恢复时间、平均住院时间均短于开腹组,分别为(75±9hVS 101±12h,P＜ 0.05)和(8.2±2.5 d VS 10.5±2.9 d,P＜ 0.05).结论 腹腔镜辅助胃癌根治术技术可行,同时具备手术视野清晰、创伤小、出血少等优点,患者近期康复效果优于开腹手术.     

70岁以上老年胃癌患者行腹腔镜辅助胃癌根治术的安全性和可行性

目的探讨70岁以上老年胃癌患者行腹腔镜辅助胃癌根治术的安全性和可行性。 方法回顾性分析2013年3月至2015年3月收治的56例老年胃癌患者临床资料,依据手术方法不同将其分成腹腔镜组与开腹组,各28例。开腹组使用传统开腹手术治疗,腹腔镜组使用腹腔镜辅助胃癌根治术,数据采用SPSS18.0统计处理,两组患者术中指标、术后恢复情况等计量资料采用( ±s)表示,行独立t检验;两组患者并发症发生率等计数资料使用%表示,行卡方检验,当P<0.05时差异有统计学意义。 结果腹腔镜组患者术中失血量、术后排气时间及术后住院时间情况显著少于开腹组,P<0.05;两组患者手术时间、淋巴结清扫数目、上下切缘距离差异无统计学意义,P>0.05;腹腔镜组患者术后有6例出现并发症(21.4%),开腹组有10例(35.7%),两组差异无统计学意义,P>0.05;但是腹腔镜组患者切口感染率为3.6%(1/28)显著低于开腹组14.3%(4/28),P<0.05; 结论70岁以上老年胃癌患者行腹腔镜辅助胃癌根治术治疗效果较好,降低了切口感染率,安全可行,值得使用与推广。     

腹腔镜与开腹胃癌根治术的临床效果对比

目的:对比腹腔镜辅助胃癌根治术与开腹胃癌根治术的临床疗效,探讨腹腔镜辅助胃癌根治术的可行性、安全性及有效性。方法:回顾分析2014年7月至2015年2月手术治疗的胃癌患者的临床资料,其中21例行开腹远端胃癌根治术;27例行腹腔镜辅助远端胃癌根治术(laparoscopically assisted distal gastrectomy,LADG);20例行开腹根治性全胃切除术;24例行腹腔镜辅助根治性全胃切除术(laparoscopically assisted total gastrectomy,LATG)。对比分析四组患者手术时间、术中出血量、术后住院时间、术后相关并发症等情况。结果:与开腹手术相比,LADG组、LATG组手术时间显著延长,但在术中出血量、胃肠功能恢复时间、术后引流管拔除时间、术后住院时间等方面具有优势。结论:腹腔镜辅助胃癌根治术安全、可靠,近期疗效肯定,具有切口小、出血少、康复快等优势,值得临床推广。     

Comparison of long-term prognosis of laparoscopy-assisted gastrectomy and conventional open gastrectomy with special reference to D2 lymph node dissection

Background

Laparoscopy-assisted gastrectomy (LAG) is becoming widely used for early gastric cancer. However, how the curability and long-term prognosis of LAG and open gastrectomy (OG) for early and advanced gastric cancer compare remains unclear. This study assessed short- and long-term outcomes after LAG with lymph node dissection in early and advanced gastric cancer.

Methods

A total of 332 patients who underwent LAG or OG for early and advanced gastric cancer from January 2001 through December 2010 were reviewed retrospectively. The mean operating time, estimated mean blood loss, number of dissected lymph nodes, and survival rates were compared between LAG and OG for early and advanced gastric cancer.

Results

Overall, 47.6% (158/332) of patients underwent LAG; D1, D1+ lymph node dissection was carried out in 77.2%, with D2 dissection in 22.8%. Only one patient required conversion to OG. Comparing LAG and OG with D1, D1+ lymph node dissection for early gastric cancer (EGC), mean operating time was significantly longer, estimated mean blood loss was significantly smaller, and the average number of retrieved lymph nodes was significantly greater with LAG. The rate of specific postoperative morbidity was 17.2% for LAG patients and 25.0% for OG patients, with no postoperative mortality. Survival and recurrence rates were not significantly different. Comparing LAG and OG with D2 lymph node dissection for advanced gastric cancer (AGC), mean operating time was significantly longer and estimated mean blood loss was significantly smaller with LAG, while the average number of retrieved lymph nodes, specific postoperative morbidity and mortality, and survival and recurrence rates were not significantly different.

Conclusions

LAG with D1, D1+ lymph node dissection for EGC is safe and equivalent to open gastrectomy in curability. Moreover, LAG with D2 lymph node dissection for AGC is comparable to OG with D2 lymph node dissection with regard to short- and long-term results.     

腹腔镜辅助胃癌根治术在老年患者中的应用研究

目的探讨腹腔镜辅助胃癌D：根治术在老年患者应用中的可行性及临床疗效。方法回顾性分析2007年10月至2012年10月间在河南大学淮河医院接受腹腔镜辅助胃癌根治术的109例老年（70岁以上）进展期胃癌患者（腹腔镜组）的临床资料,并与同期开腹胃癌根治术的124例老年患者（开腹组）的临床资料进行对比分析。结果与开腹组相比,腹腔镜组患者术中出血量更少[（102．5±34．3）ml比（181．7±73．8）ml,P〈0．05],术后肠功能恢复更快[（2．8±0．6）d比（4．0±1．2）d,P〈0．05],术后住院时间更短[（10．7±7．5）d比（14．2±6．5）d,P〈0．05],术后并发症发生率更低[10．1％（11／109）比21．0％（26／124）,P〈0．05],但手术时间较长[（231．2±51．4）min比（208．5±53．6）min,P〈0．05],两组患者淋巴结清扫枚数相当（31．4±14．2比32．6±11．7,P〉0．05）。腹腔镜组术后短期生活质量明显优于开腹组（P〈0．05）。腹腔镜组和开腹组术后5年生存率分别为54．5％和59．2％,差异无统计学意义（P〉0．05）。结论老年患者行腹腔镜辅助胃癌根治术能达到与开腹手术相似的根治效果,且微创优势显著。     

Comparison of long-term results between laparoscopy-assisted gastrectomy and open gastrectomy with D2 lymph node dissection for advanced gastric cancer

Background

Laparoscopy-assisted gastrectomy (LAG) has been established as a low-invasive surgery for early gastric cancer. However, it remains unknown whether it is applicable also for advanced gastric cancer, mainly because the long-term results of LAG with D2 lymph node dissection for advanced gastric cancer have not been well validated compared with open gastrectomy (OG).

Methods

A retrospective cohort study was performed to compare LAG and OG with D2 lymph node dissection. For this study, 167 patients (66 LAG and 101 OG patients) who underwent gastrectomy with D2 lymph node dissection for advanced gastric cancer were reviewed. Recurrence-free survival and overall survival time were estimated using Kaplan–Meier curves. Stratified log-rank statistical evaluation was used to compare the difference between the LAG and OG groups stratified by histologic type, pathologic T status, N status, and postoperative adjuvant chemotherapy. The adjusted Cox proportional hazards regression models were used to calculate the hazard ratios (HRs) of LAG.

Results

The 5-year recurrence-free survival rate was 89.6% in the LAG group and 75.8% in the OG group (nonsignificant difference; stratified log-rank statistic, 3.11; P?=?0.0777). The adjusted HR of recurrence for LAG compared with OG was 0.389 [95% confidence interval (CI) 0.131–1.151]. The 5-year overall survival rate was 94.4% in the LAG group and 78.5% in the OG group (nonsignificant difference; stratified log-rank statistic, 0.4817; P?=?0.4877). The adjusted HR of death for LAG compared with OG was 0.633 (95% CI 0.172–2.325).

Conclusions

The findings show that LAG with D2 lymph node dissection is acceptable in terms of long-term results for advanced gastric cancer cases and may be applicable for advanced gastric cancer treatment.     

腹腔镜与开腹手术治疗胃癌的比较研究

目的：通过比较同期开展的腹腔镜胃癌根治术与传统开腹胃癌根治术,评价腹腔镜胃癌根治术的效果,以期为腹腔镜胃癌手术的进一步开展提供参考依据。方法：选取2008年9月—2010年6月接受手术的178例胃癌患者为研究对象,其中106例采用传统开腹胃癌根治术（传统开腹组）,72例患者接受腹腔镜胃癌根治术（腹腔镜手术组）。腹腔镜手术组与传统开腹组在性别、年龄、肿瘤位置、病理类型和TNM分期差异无统计学意义。结果：2组在手术时间、出血量、胃肠道恢复时间、术后首次进食流质时间和术后住院时间差异有统计学意义。结论：腹腔镜胃癌手术较传统胃癌手术具备了切口小、出血量小,胃肠道恢复时间短、术后住院时间缩短等优势。     

Long-term quality of life after laparoscopy-assisted distal gastrectomy for gastric cancer

Background Laparoscopy-assisted distal gastrectomy (LAG) is gaining acceptance for treating early gastric cancer. However, the long-term quality of life after LAG for gastric cancer is unknown. This study compared the long-term quality of life after LAG versus open distal gastrectomy (ODG) for early gastric cancer. Method This study included 53 patients who underwent LAG and 37 patients who underwent ODG for treatment of early gastric cancer. Quality of life was evaluated on the basis of a 22-item questionnaire that addressed food tolerance and mental and physical conditions, scored on a scale of 1–3. Results The mean follow-up periods after LAG and ODG were 99.3 and 97.0 months, respectively. Although the majority of patients who had undergone LAG were consuming a normal diet and had weight loss of less than 5 kg, all 22 items and the total score of the LAG group were comparable to those of the ODG group. However, the incidence of postoperative intestinal obstruction was significantly lower in the LAG group than in the ODG group (1% vs. 13%, p < 0.05). Conclusions LAG is equivalent to ODG with respect to long-term quality of life and is associated with a reduced incidence of postoperative intestinal obstruction. This work was supported in part by a Grant-in-Aid for Scientific Research (No. 15390401) from the Japanese Ministry of Education, Science, and Culture     

腹腔镜胃癌D2根治术218例疗效评价

目的 探讨腹腔镜胃癌D2根治术的可行性及其疗效.方法 2007年1月至2009年3月,对529例胃癌患者施行胃癌D2根治术,其中腹腔镜手术患者(腹腔镜组)218例,开腹手术患者(开腹组)311例.对两组患者的术中及术后情况、淋巴结清扫数目、并发症及病死率等进行比较分析.结果 腹腔镜组手术时间为(237±42)min长于开腹组的(229±42)min,而两组术中出血量[(81±100)ml比(171±211)ml]、术中输血例数(7例比44例)、术后胃肠功能恢复时间[(4.1 ±2.3)d比(5.0±1.4)d]、首次进流质时间[(4.5±2.2)d比(5.5 ±1.4)d]和术后住院时间[(12±4)d比(14±4)d]等差异均有统计学意义(P<0.05),腹腔镜组均优于开腹组.在腹腔镜组中,全胃切除术的手术时间为(250±46)min,显著长于远端胃大部切除术的(228±37)min(P<0.05),而两种术式在其他方面均无显著差异.腹腔镜组和开腹组术后并发症发生率分别为11.9%和19.0%,差异有统计学意义(P<0.05).腹腔镜胃癌手术的中转开腹率为6.0%.全组患者平均淋巴结清扫数目为(29±10)枚,中位数为28枚.腹腔镜组和开腹组患者平均淋巴结清扫数目分别为(28±10)枚和(29±9)枚,差异无统计学意义(P>0.05).结论 腹腔镜胃癌D2根治术具有安全、术后恢复快和并发症少等优点,同时在淋巴结清扫方面能达到与开腹手术相同的效果.     

Surgical outcomes of laparoscopy-assisted gastrectomy versus open gastrectomy for gastric cancer: a case-control study

Background

The aim of this study was to clarify the technical feasibility and oncological efficacy of laparoscopy-assisted gastrectomy (LAG) for gastric cancer compared with open gastrectomy (OG).

Methods

Between April 2002 and March 2008, a series of 623 patients with gastric cancer underwent R0 gastrectomy (314 LAG patients and 309 OG patients). Age, gender, lymph node dissection, and pathological stage were matched by propensity scoring, and 212 patients (106 LAG and 106 OG) were selected for analysis after the exclusion of 40 patients who had proximal gastrectomy. Intraoperative factors, postoperative morbidity, long-term quality of life (QOL), and survival were evaluated. Moreover, these outcomes were also compared between the laparoscopy-assisted total gastrectomy (LATG) and the open total gastrectomy (OTG).

Results

There was no significant difference in preoperative characteristics between the two patient groups. Regarding intraoperative characteristics, blood loss was significantly lower in the LAG group (143?ml) than in the OG group (288?ml), while operation time was significantly longer in the LAG group (273?min) than the OG group (231?min). The degree of lymph node dissection and number of retrieved lymph nodes did not differ between the two groups. There were no significant differences in postoperative courses or overall and disease-specific survival (89.8% vs. 83.6%, P?=?0.0886; 100% vs. 95.2%, P?=?0.1073) except time to first flatus and time to use of nonsteroidal anti-inflammatory derivatives between the two groups. Significantly fewer patients felt wound pain in the LAG group 1?year after surgery. Analyses between the LATG and OTG groups showed similar results.

Conclusions

LAG for gastric cancer may be both feasible and safe. However, it will be necessary to conduct a well-designed randomized controlled trial comparing short-term and long-term outcomes between LAG and OG in a larger number of patients.     

Comparison of laparoscopically assisted and open radical distal gastrectomy with extended lymphadenectomy for gastric cancer management

Background The feasibility and safety of laparoscopically assisted gastrectomy with extended lymphadenectomy for advanced gastric cancer has rarely been studied. This study aimed to investigate the feasibility, safety, and cancer clearance of laparoscopically assisted distal gastrectomy with D2 lymphadenectomy. Methods Of the 44 patients with distal gastric cancer who underwent radical distal gastrectomy from March 2004 to May 2005, 35 were treated with D2/D2⁺ lymphadenectomy. These patients were compared with 58 patients who, during the same period, underwent a conventional open radical distal gastrectomy. Results The mean total number of retrieved lymph nodes (30.11 ± 16.97) and the mean tumor margin were comparable with those in the open group. The mean operative time for laparoscopically assisted distal gastrectomy was significantly longer than for open surgery (282.84 ± 32.81 min vs 223.75 ± 23.25 min). The patients in the laparoscopic surgery group had less blood loss, shorter times of analgesic injection, and a faster recovery. The rates of complications were comparable between two groups. Conclusions Although laparoscopically assisted radical gastrectomy with D2 lymphadenectomy is more time consuming than open surgery, it is a safe, feasible procedure that achieves cancer clearance similar to open surgery and leads to a quick postoperative recovery.