腹腔镜辅助与开腹胃癌D2根治术的对比研究

目的探讨腹腔镜辅助胃癌D2根治术的可行性及近期疗效。方法2010年3月～2012年12月，施行361例胃癌D2根治术，2组医生分别手术，腹腔镜组166例，开腹组195例。对2组术中及术后情况、淋巴结清扫数目、并发症及病死率等进行比较。结果腹腔镜组手术时间（241±55）min]、淋巴结清扫数（29．8±6．5）个]与开腹组（237±53）min、（30．5±7．0）个]差异无显著性（t=0．702、-0．978，P=0．438、0．329），而腹腔镜组术中出血少（115±59）ml vs．（259±121）ml，t=-13．981，P=0．000]，术中输血例数少（7例 vs．19例，=4．098，P=0．043），术后排气时间早（3．6±0．9）dV8．（5．1±1．5）d，t=-11．271，P=0．000]，首次进流质时间早（6．1±1．3）dVS．（8．1±1．4）d，t=-13．977，P=0．000]，术后住院时间短（11．9±2．5）d VS．（14．3±3．2）d，t=-7．838，P=0．000]。腹腔镜组并发症发生率低12．7％（21／166）VS．24．6％（48／195），X^2=8．303，P=0．004]，其中肺部感染的发生率明显低于开腹组3．0％（5／166）vs．8．7％（17／195），X^2=5．101，P=0．024]。结论腹腔镜辅助胃癌D2根治术具有安全可行、术后恢复快和并发症少等优点，同时在淋巴结清扫及近期预后方面能达到与开腹手术相同的效果。

A Comparative Study of Laparoscopic-assisted D2 Radical Gastrectomy and Open Surgery among 166 Patients with Gastric Cancer

Objective To explore the feasibility and short-term effectiveness of laparoscopic-assisted D2 radical gastrectomy for gastric cancer. Methods A total of 361 patients with gastric cancer underwent D2 radical gastrectomy between March 2010 and December 2012, in which 166 patients underwent laparoscopic surgery （laparoscopy group） while 195 patients underwent open surgery （ open surgery group）. The intraoperative and postoperative condition, numbers of lymph node removed, complications and fatality rate between the two groups were compared. Results The operation time （241 ± 55） min and number of lymph node removed （29.8 ± 6.5） in laparoscopy group were not significantly different from the operation time （237 ± 53） min and number of lymph node removed （30.5 ± 7.0） in open surgery group （t = 0. 702, -0. 978 ;P = 0. 438,0. 329）. Compared with open group, laparoscopy group had less intraoperative blood loss （ 115 ± 59） ml vs. （259 ± 121 ） ml,t = - 13. 981, P = 0. 000 ], less intraoperative blood infusion cases （ 7 vs. 19）, ）（2 ： 4.098, P = 0. 043 ], earlier postoperative flatus （ 3.6 ± 0.9 ） d vs. （ 5.1 ± 1.5 ） d, t = - 11. 271, P = 0. 000 ], earlier liquid food intake （6.1 ±1.3）d vs. （8.1 ±1.4）d,t = -13.977,P=0.000] and shorter postoperative hospital stays （11.9±2.5） d vs. （ 14.3 ± 3.2） d, t = - 7. 838, P = 0. 000] . Compared with open group, laparoscopic group had lower complication rate 12.7% （21/166） vs. 24.6% （48/195）, X^2 = 8. 303, P = 0. 004 ] and significantly less incidence of pulmonary infection 3.0% （5/166） vs. 8.7% （ 17/195 ） , X^2 = 5. 101 ,P = 0. 024]. Conclusions Laparoscopic-assisted D2 gastrectomy for gastric cancer is safe and feasible, characterized by rapid postoperative recovery and few complications. It can also achieve similar effects in lymph node dissection and short-time prognosis as compared to open surgery.