腹腔镜辅助与开腹根治性全胃切除术近远期疗效对比

目的:通过比较腹腔镜辅助根治性全胃切除术与开腹根治性全胃切除术近远期疗效差异，探讨腹腔镜辅助根治性全胃切除术的临床应用价值。方法:总结从2013年6月到2015年12月在西安交通大学第一附属医院普通外科诊断为胃腺癌或黏液腺癌并行根治性全胃切除129例患者临床病例资料，将患者分为腹腔镜组与开腹组，通过比较两组患者术后近期疗效、手术相关指标、术后病理指标及远期疗效，比较两种手术疗效差异。结果:两组患者一般资料及病理资料无统计学差异。与开腹组相比腹腔镜组术中出血量明显减少、术后住院时间明显减低、术后总体并发症发生率降低，并且术中术后输血率降低，而开腹组手术时间低于腹腔镜组，住院总花费也低于腹腔镜组。两组患者术后总生存率与无病生存率相同。结论:腹腔镜辅助根治性全胃切除术是安全可行的，与开腹手术相比，其具有微创、术后恢复快的特点，并且两组患者远期疗效一致，值得临床推广应用。

The short and long term effect of laparoscopic assistant vs laparotomy radical total gastric resection for gastric cancer

Objective:To compare the short and long term effect of laparoscopic assistant and laparotomy total gastrectomy and investigate the clinical significance of laparoscope surgery for gastric cancer patients.Methods:129 patients who had diagnosed as gastric adenocarcinoma or mucinous adenocarcinoma and suffered radical surgical total gastrectomy in the department of General Surgery of the First Affiliated Hospital of Xi'an Jiaotong University during June 2013 to December 2015 were collected.These patients were non-randomly divided into laparoscopic group and laparotomy group.The effect of two kinds of operations was compared by the short time clinical data，pathological data，operation relative data and long term effect.Results:There was no difference of general data and pathological data between two groups.The laparoscopic group had less blood loss，shorter postoperative hospital stay time，and lower postoperative complications occurrence rate，lower transfusion rate.However，the operation time was longer and the cost was more expensive in the laparoscopic group when compared to the laparotomy group.There was no significance of total survival and disease free survival rate between the two groups.Conclusion:Laparoscopic assistant radical total gastrectomy is feasibiliable and secure.Compared to the laparotomy surgery，the laparoscopic surgery has minimally invasive effect and faster postoperative recovery，and the long term effect is same as the laparotomy surgery，which deserving popularizing.