远端进展期胃癌腹腔镜辅助与开腹 D2根治术淋巴结清扫的临床对照研究

目的：比较腹腔镜辅助与开腹D2根治术在远端进展期胃癌淋巴结清扫中的效果。方法对2012年1月～2013年10月共44例远端进展期胃癌进行前瞻性研究，根据患者意愿分别行腹腔镜辅助胃癌根治术（腹腔镜组）24例和开腹胃癌根治术（开腹组）20例，比较2组临床情况、各站淋巴结清扫数目及随访结果。结果腹腔镜组2例中转开腹被排除。与开腹组相比，腹腔镜组手术时间长[（312．4±42．8）min vs．（256．2±28．6）min，t＝4．942，P＝0．000]；但术后排气早[（3．2±1．3）d vs．（4．6±1．1）d，t＝-3．750，P＝0．000]，下床活动早[（3．0±1．2）d vs．（4．2±1．3）d，t＝-3．110，P＝0．004]，术后住院时间短[（7．8±3．2）d vs．（14．4±5．6）d，t＝-4．750，P＝0．000]。术中出血量2组差异无显著性[（304．8±112．4）ml vs．（285．6±86．6）ml，t＝0．615，P＝0．247]。2组每例清扫淋巴结数目差异无显著性[（19．4±9．2）枚vs．（20．2±12．0）枚，t＝-0．241，P＝0．652]，其中第一站淋巴结2组差异无显著性[（15．4±6．8）枚vs．（16．3±7．3）枚，t＝-0．414，P＝0．431]，第二站淋巴结腹腔镜组少于开腹组[（4．8±3．4）枚vs．（7．4±2．8）枚，t＝-2．690，P＝0．008]。随访6～35个月，平均17个月。腹腔镜组3例死亡，3例复发转移带瘤生存；开腹组4例死亡，2例复发转移带瘤生存。结论在进展期胃癌D2根治术中，虽然腹腔镜组第二站淋巴结清扫数目不及开腹组，但从总体而言，腹腔镜辅助手术能够达到与开腹手术相当的淋巴结清扫效果，且具有微创优势。

A Clinical Comparative Study on Lymph Node Dissection Between Laparoscopic-assisted and Open Distal D2 Gastrectomy for Advanced Gastric Cancer

Objective To compare the efficacy of lymph node dissection between laparoscopy -assisted and open distal D 2 gastrectomy for advanced gastric cancer . Methods Clinical data of 42 patients with advanced gastric cancer from January 2012 to October 2013 were studied prospectively .According to their own choice , patients were divided into either laparoscopic-assisted group （LAG, n=24） or open group （OG, n=20）.The operative time, blood loss, time to first flatus, time to get out of bed, postoperative hospital stay , number of retrieved lymph nodes , and the follow-up results were compared respectively between the two groups . Results Two patients were exduded because of conversion to open surgery .As compared with the OG group , the operative time in the LAG group was significantly longer [（312.4 ±42.8） min vs.（256.2 ±28.6） min, t=4.942, P=0.000], the first flatus time was significantly shorter [（3.2 ±1.3） d vs.（4.6 ±1.1） d, t=-3.750, P=0.000], the time to get out of bed was significantly shorter [（3.0 ±1.2） d vs.（4.2 ±1.3） d, t=-3.110, P=0.004], and the postoperative hospital stay was significantly shorter [（7.8 ± 3.2） d vs.（14.4 ±5.6） d, t=-4.750, P=0.000].However, the blood loss was not significantly different between the two groups [（304.8 ±112.4） ml vs.（285.6 ±86.6） ml, t =0.615, P =0.247].The mean number of retrieved lymph nodes was not significantly different between the two groups [（19.4 ±9.2） in LAG group vs.（20.2 ±12.0） in OG group, t =-0.241, P=0.652].There were no significant differences in the number of N 1 lymph nodes between the two groups [（15.4 ±6.8） vs.（16.3 ±7.3）, t=-0.414, P=0.431], while the number of N2 lymph nodes in LAG group was significantly less than that in the OG group [（4.8 ±3.4） vs.（7.4 ±2.8）, t=-2.690, P=0.008].The median duration of follow-up was 17 months （6-35 months）.In the LAG group, 3 patients died during the follow-up period.Tumor recurrences or metastases happened in 3 patients and they