进展期胃中上部癌行腹腔镜与开腹根治性全胃切除术的围手术期疗效比较

目的：前瞻比较进展期胃中上部癌行腹腔镜辅助根治性全胃切除术与开腹根治性全胃切除术的疗效。方法：选取胃中上部癌患者共67例,随机分为两组,分别施行腹腔镜辅助及开腹根治性全胃切除（D2）,比较围手术期疗效。结果：腔镜组与开腹组相比,清扫淋巴结总数目基本一致,围腹腔动脉周围、贲门区域以及大小网膜区域清扫淋巴结数两组均无显著性差异;但围脾门区域和幽门区域清扫淋巴结数腔镜组比开腹组具有明显优势（P〈0.05）。腔镜组术中出血量较少（P〈0.05）,术后疼痛减轻（P〈0.05）,胃肠功能恢复快（P=0.053）,但手术时间较长（P〈0.05）,术后肺部感染发生率升高（P=0.067）。两组的标本上切缘与肿瘤距离及术后腹部并发症发生率基本一致。结论：对进展期胃癌,腹腔镜下行根治性全胃切除术（D2）具有较好的围手术期疗效,尤其在围脾门区域和幽门区域淋巴结清扫方面比开腹手术更具优势,但需注意加强术后肺部管理。

Laparoscopic-Assisted versus Open Total Gastrectomy(D2) for Advanced Gastric Cancer Located in the Upper or Middle Third Portion of the Stomach: Perioperative Results of a Randomized Prospective Trial

Objective：To compare the perioperative outcome of laparoscopic-assisted total gastrectomy（LATG） and conventional open total gastrectomy（OTG） for advanced upper and middle Gastric cancer.Methods： Sixty-severn patients in a single institution between Sept 2008 and July 2009 were randomly devided into two groups,who underwent LATG and OTG（D2） respectively.We prospectively assessed the peri-operative outcomes of them.Results： No significant difference between two groups was observed in the number of harvested lymph nodes of total,around peri-celiac artery and along the branch（the left gastric artery,the common hepatic artery,the proximal splenic artery）,cardiac part,greater and lesser omentum.The number of peri-spenic hilum（include at the spenic hilum and along the distal splenic artery） and pyloric part lymph nodes clearance in LATG was significantly more than that in OTG（P=0.03,P=0.038）.Patient who received LATG had lower degree of pains,quicker recovery of bowel function,more mean operative time,higher rate of pulmonary infection as compared with those underwent OTG.There was significant difference between two groups in mean blood lost but not in the length of the proximal resection margin.The early postoperative abdominal complications were similar in the two groups.Conclusions： Short-term results with laparoscopic-assisted total gastrectomy（D2） were better than with open surgery in this study especially in peri-spenic hilum and pyloric part lymph nodes clearance.But in the authors′ experience pulmonary management should be enhanced in the patients performed LATG.