中上部进展期胃癌患者的微创手术效果研究

目的探讨中上部进展期胃癌(AGC)患者的微创手术效果。方法选取2009年1月-2013年12月该院收治的167例行全胃切除术+D2淋巴结清扫术的中上部AGC患者为研究对象,根据手术方式将所有患者分为腹腔镜辅助全胃切除术组(LATG)(n=57)和开腹全胃切除术组(OTG)(n=110),比较两组的基线资料、术中、术后资料及随访结果。结果 (1)两组各基线资料比较,差异均无统计学意义(P0.05),具有可比性;(2)LATG组的术中失血量、切口长度明显低于OTG组,差异有统计学意义(P0.05)。两组的手术时间、术中输血比例、上切缘距离癌灶的距离、淋巴结清扫数目比较,差异均无统计学意义(P0.05);(3)LATG组的术后首次排气时间、恢复流质进食时间、术后住院天数和术后3天内疼痛视觉模拟评分(VAS)等明显低于OTG组,差异有统计学意义(P0.05)。两组的术后并发症发生率比较,差异无统计学意义(P0.05);(4)所有患者在术后30天内均未出现死亡,全部患者均获得术后随访,中位随访时间为38.2个月(1~58个月)。LATG组和OTG组患者术后1和3年的总生存率分别为87.7%与83.6%、71.9%与64.5%,两组比较差异均无统计学意义(P0.05)。结论对于中上部AGC患者而言,LATG+D2淋巴结清扫术具有术中出血量少、切口短、术后恢复快和住院时间短等优点,安全有效,近、远期效果令人满意。

Minimally invasive surgery in patients with middle-upper advanced gastric cancer

Objective?To investigate the effect of minimally invasive surgery in patients with midge-upper advanced gastric cancer (AGC).?Methods?167 patients with middle-upper AGC underwent total gastrectomy+D2 lymph node dissection from January 2009 to December 2013 were enrolled in the study and divided into laparoscopic assisted total gastrectomy (LATG) group (n = 57) and open total gastrectomy (OTG) group (n = 110). Baseline data, operative, postoperative data and follow-up result were compared between the two groups.?Results?There were no significant differences in baseline data between the two groups (P > 0.05); The intraoperative blood loss and incision length in LATG group were significantly lower than that in OTG group (P < 0.05). There were no significant differences in operation time, ratio of intraoperative blood transfusion, distance between the upper margin and the tumor, the number of lymph node dissection between two groups (P > 0.05); Postoperative first aerofluxus time, ecovery liquid diet time, postoperative hospitalization days and VAS score of pain in 3 d after operation in LATG group were significantly lower than that in OTG group (P < 0.05). There was no significant differences in incidences of postoperative complication between two groups (P > 0.05); There was no patient dying within 30 d after surgery. The median follow-up time was 38.2 months (1~58 months). Postoperative 1, 3 year overall survival rates in LATG group and OTG group were 87.7% and 83.6%, 71.9% and 64.5%, and there were no significant differences between the two groups (P > 0.05).?Conclusion?For patients with middle-upper AGC, LATG+D2 lymph node dissection has lots of advantages including less intraoperative blood loss, shorter incision, faster postoperative recovery, shorter hospital stay and so on, which is safe and effective, and their short-and long-term results are satisfactory.