全腹腔镜胃癌D2根治术治疗高龄胃癌患者的安全性及生存分析

目的:评价全腹腔镜胃癌D2根治术治疗高龄胃癌患者的安全性及对患者生存的分析。方法:采用回顾性病例对照研究的方法，纳入2012年10月到2016年9月在空军军医大学附属唐都医院胃肠外科行手术治疗的70岁以上胃癌患者108例，根据手术方式差异分为腹腔镜组(n=54)和开腹组(n=54)。收集并分析两组患者的临床病理学资料和术后30天内并发症发生情况及生存状况。结果:两组术前一般特征及术后病理学特征比较未见统计学差异(P>0.05)。与开腹组相比，腹腔镜组术中出血量、围手术期输血更少(69.6±44.6 vs 234.1±110.5，P=0.000；27.8% vs 53.7%，P=0.006)，术后首次通气时间早(3.0±1.1 vs 3.8±1.1，P=0.000)，且术后住院时间短(7.4±3.4 vs 9.3±4.0，P=0.011)。开腹组术后30天内非腹部并发症发生率更高(29.6% vs 9.3%，P=0.007)，但两组腹部并发症(18.5% vs 11.1%，P=0.302)和严重并发症比较(7.4% vs 1.9%，P=0.206)未见统计学差异。腹腔镜组1年、2年及3年累计生存率分别为87.6%、80.1%及58.6%，开腹组1年、2年及3年累计生存率分别为84.8%、68.9%和54.3%，组间比较未见统计学差异(P>0.05)。结论:全腹腔镜D2根治术治疗高龄胃癌患者安全可行，且具有术中出血少、术后首次通气时间早、术后住院时间短的优势，患者术后远期生存情况与传统开腹手术相当。

Safety and survival analysis of total laparoscopic gastrectomy with D2 lymph node dissection for gastric cancer in elderly patients

Objective:To evaluate the safety and long-term outcome of total laparoscopic gastrectomy with D2 lymph node dissection in elderly patients with gastric cancer.Methods:A case-control study was conducted in 108 gastric patients who were more than 70 years old.They underwent either totally laparoscopic gastrectomy (LG，n=54) or open gastrectomy (OG，n=54) in Tangdu hospital between October 2012 and September 2016.The clinicopathological information，postoperative complications within 30 days and survival time were collected and analyzed retrospectively.Results:No significantly statistic difference was observed in clinical characteristics and pathological findings between two groups.Compared with OG group，intraoperative blood loss (69.6±44.6 vs 234.1±110.5，P=0.000) and peri-operative blood transfution (27.8% vs 53.7%，P=0.006) were less，time to flatus was earlier (3.0±1.1 vs 3.8±1.1，P=0.000)，and hospitalization after surgery was shorter (7.4±3.4 vs 9.3±4.0，P=0.011) in LG group.There was no difference between two groups in abdominal complications (18.5% vs 11.1%，P=0.302) and severe complications (7.4% vs 1.9%，P=0.206)，whereas non-abdominal complications occurred more often in OG group (29.6% vs 9.3%，P=0.007).The 1-year，2-year，and 3-year survival rate of LG group were 87.6%，80.1%，and 58.6%，which were comparable to survival rate of OG group (84.8%，68.9% and 54.3%)，respectively (P>0.05).Conclusion:Compared with OG，totally laparoscopic gastrectomy with D2 lymph node dissection can be performed safely in elderly patients，with comparable postoperative long-term survival.