腹腔镜辅助下D2根治术对进展期远端胃癌患者临床疗效、术后并发症及住院时间的影响

目的 探讨腹腔镜辅助下D2根治术对进展期远端胃癌患者临床疗效、术后并发症及住院时间的影响.方法 选取进展期远端胃癌患者80例,按照治疗方法的不同将其分为腹腔镜组和传统开腹组,每组40例,其中,腹腔镜组患者行腹腔镜辅助下远端胃癌D2根治术,传统开腹组患者行传统开腹远端胃癌D2根治术.比较两组患者的手术指标、肿瘤根治术有效性和术后并发症的发生情况.结果 与传统开腹组比较,腹腔镜组患者的平均手术时间、术后排气时间、术后进流食时间、术后下床活动时间和平均住院时间均缩短(160.55±13.21)min、(4.21±0.64)d、(4.18±0.79)d、(2.89±0.86)d、(13.27±2.66)d],术中平均出血量减少(152.40±27.02)ml],平均手术切口长度缩短(6.03±0.80)cm],差异均有统计学意义(P﹤0.01).腹腔镜组经术后病理检查证实的近切端与肿瘤平均距离、远切端与肿瘤平均距离、淋巴结平均清扫总数分别为(7.09±1.04)cm、(6.09±1.06)cm、(29.25±18.13)枚,与传统开腹组比较,差异无统计学意义(P﹥0.05).腹腔镜组患者术后并发症的总发生率为10％(4/40),与传统开腹组的20％(8/40)比较,差异无统计学意义(χ2=0.180,P=0.671).结论 腹腔镜辅助下D2根治术对进展期远端胃癌患者的肿瘤根治有效性高,缩短了患者住院时间,减少了患者术后并发症的发生,具有较高的安全性,可广泛应用于临床.

The effect of laparoscopic assisted radical D2 resection on the clinical efficacy,postoperative complications and hospital stay in patients with advanced distal gastric cancer

Objective To investigate the effect of laparoscopic assisted radical D2 resection on the clinical efficacy, postoperative complications and hospital stay in patients with advanced distal gastric cancer. Method 80 cases of ad-vanced distal gastric cancer patients, including 40 cases who underwent laparoscopic assisted radical D2 resection, and an-other 40 cases which were administered with conventional radical D2 resection for distal gastric cancer, were included in the study as laparoscopic surgery group and conventional laparotomy group, respectively. The surgery indexes, efficacy of radical resection and incidence of postoperative complications were compared between the two groups. Result Com-pared with the conventional laparotomy group, the average operative time, postoperative exhaust time, time for liquid di-et, ambulation time after surgery, and hospital stay in laparoscopic surgery group were decreased (160.55 ± 13.21) min, (4.21±0.64) d, (4.18±0.79) d, (2.89±0.86) d, (13.27±2.66) d], with less intraoperative blood loss (152.40±27.02) ml] and shorter average incision length (6.03±0.80) cm], and all differences were of statistical significance (P<0.05). Average dis-tance between proximal and distal tumor, the distance from distal incision and tumor, and the average number of lymph node dissection in laparoscopic surgery group by postoperative confirmation were (7.09 ± 1.04) cm, (6.09 ± 1.06) cm, and (29.25±18.13), which were similar with the conventional laparotomy group (P>0.05). The overall incidence of postopera-tive complications in the laparoscopic surgery group was 10％ (4/40), the overall incidence of postoperative complica-tions in the conventional laparotomy group at 20％ (8/40), they were of no significant difference (χ2=0.180, P=0.671). Conclusion Laparoscopic assisted radical D2 resection is effective in the treatment of patients with advanced distal gas-tric cancer, which shortens the time of hospitalization while lowers the incidence of postoperative complications, with ac-ceptable safety and applicability.