腹腔镜D2胃癌根治术的疗效及并发症分析

目的探讨腹腔镜D2胃癌根治术对胃癌患者的淋巴结清扫数目、安全性及远期预后的影响。方法选取2011年1月至2013年12月接受胃癌根治性手术治疗的190例患者进行回顾性分析,根据手术方式分为腹腔镜组98例、开腹组92例,数据统计分析采用SPSS 16.0进行处理,所有计量指标均采用均数±标准差(±s)进行统计描述,采用两组独立样本的t检验;并发症发生率、3年生存率比较采用χ~2检验;生存时间分析采用Kaplan-meier法;P值0.05表示差异具有统计学意义。结果腹腔镜组患者的手术时间长于开腹组(P0.05);腹腔镜组患者的手术出血量、切口长度、肛门排气时间、术后镇痛药使用率、胃肠减压时间、住院时间均低于开腹组(P0.05),两组患者的清扫淋巴结数目、阳性淋巴结数目差异无统计学意义(P0.05);腹腔镜组患者的手术并发症发生率12.2%低于开腹组的25.0%(P0.05);开腹组患者的3年生存率52.5%低于腹腔镜组的60.5%,但差异无统计学意义(P0.05)。结论腹腔镜D2胃癌根治术相对于传统开腹手术具有创伤程度低、术后恢复快、并发症少的优势,同时手术效果基本相当。

Efficacy and complications of laparoscopic D2 radical gastrectomy for gastric cancer

Objective To investigate the effect of laparoscopic D2 radical gastrectomy on the number of harvested lymph nodes,safety and long-term prognosis of patients with gastric cancer.MethodsAn retrospective analysis was performed in 190 patients who underwent radical gastrectomy for gastric cancer from January 2011 to December 2013.A according to the operation modes,98 cases were divided into laparoscopic group and 92 cases were divided into traditional laparotomy group.Statistical analysis were performed by using SPSS 16.0 software.Measurement data such as perioperative indicators were expressed as mean±standard deviation(x-±s),and were examined by using t test.Count data,such as postoperative complication rate and 3-years-survival rate were expressed as％,and were examined by using x2 test.Survival analysis were performed by using Kaplan-meier method.A P value <0.05 was considered as statistically significant difference.Results The operation time in laparoscopic group was longer than that in laparotomy group(P<0.05).Compared with traditional group,in laparoscopic group there were shorted surgical incision length,less blood loss,quicker anal exhaust time,lower postoperative analgesic use,less hospital stay and shorter gastrointestinal decompression time(P<0.05).There was no significant difference of the number of lymph nodes between two groups(P>0.05).The complication rate of laparoscopic group was 12.2％,which was lower than 25.0％in open surgery group(P<0.05).The 3-years-survival rate open group was 52.5％,which was lower than 60.5％in laparoscopic group,with no significant difference(P>0.05).Conclusion Compared with the traditional open surgery,laparoscopic D2 radical gastrectomy has the advantages of less trauma,faster postoperative recovery and less complications.