开腹及腹腔镜辅助根治性远端胃切除的对比研究

目的探讨腹腔镜辅助根治性远端胃切除术的可行性。方法回顾性分析我院2011年3月～2012年6月行腹腔镜辅助及开腹根治性远端胃切除术各16例的临床资料。比较2组手术时间、出血量、清扫淋巴结数、术后肛门排气时间、开始流质饮食时间及并发症。结果与开腹组相比，虽然腹腔镜组手术时间长（183．4±20．2）min VS．（143．44±21．6）ｍin，t=5．400，P=0．000]，但术中出血少（157．5±30．1）mlV8．（183．1±28．4）ml，t=－2．474，P=0．010]，肛门排气早（2．84±0．3）dVS．（3．64±0．3）d，t=－7．005，P=0．000]，开始进流食早（2．9±0．2）dV8．（4．0±0．2）d，t=－13．421，P=0．000]。2组淋巴结清扫数目、并发症差异无显著性（P〉0．05）。腹腔镜组术后肺部感染3例，胃瘫1例，吻合口出血1例；开腹组术后肺部感染2例，胃瘫2例，切口感染或脂肪液化3例。结论腹腔镜辅助根治性远端胃切除术方法安全、可行，早期疗效与开腹相同，同时具有视野清晰、创伤小、出血少、恢复快等优点。

Comparative Study of Laparotomy and Laparoscopic-assisted Radical Distal Gastrectomy

Objective To explore the feasibility of laparoscopic-assisted radical distal gastrectomy. Methods We retrospectively reviewed the clinical data of 16 cases undergoing laparoscopic gastrectomy （laparoscopie group） and 16 cases undergoing open gastrectomy （open group） in our hospital from March 2011 to June 2012. The operation time, intraoperative blood loss, number of lymph node dissected, postoperative anal exhaust time, time to liquid diet, and complications were compared between the two groups. Results Compared with the open group, the operation time of laparoscopic gastrectomy was longer （183.4 ± 20.2） minvs. （143.4 ±21.6） min, t =5.400, P=O. 000], but the hemorrhage volume was less （157.5 ±30.1） ml vs. （ 183.1 ± 28.4） ml, t = - 2. 474, P = 0. 010 ], the anal exhaust time after operation was earlier （2.8 ± O. 3 ） d vs. （ 3.6 ± 0.3） d, t = - 7. 005, P = 0. 000 ] , and time to liquid diet after operation was earlier （2.9 ± 0.2） d vs. （4.0 ± 0.2） d, t = - 13. 421, P = 0. 000 ]. There were no differences in number of lymph nodes removed and complications between the two groups （P 〉 O. 05）. In the laparoscopic group, there were 3 cases of pulmonary infection, 1 case of gastric paralysis, and 1 case of anastomotic bleeding. In the open group, there were 2 cases of pulmonary infection, 2 cases of gastric paralysis, and 3 cases of incisional infection or fat liquefaction. Conclusions Laparoscopic gastrectomy is feasible and safe for patients with gastric cancer. It can be performed safely with comparable early curative effects to open gastrectomy, bearing advantages of clear vision, small trauma, less bleeding, and fast recovery.