腹腔镜与开腹进展期胃癌D2根治术的临床对照研究

目的探讨对进展期胃癌患者进行腹腔镜D2根治性手术的安全性和可行性。方法回顾性分析2007年5月至2010年12月间在苏北人民医院接受腹腔镜下根治性切除术的210例进展期胃癌患者（腹腔镜组）的临床资料，并与同期行开腹胃癌根治术的180例进展期胃癌患者（开腹组）的临床资料进行比较分析。结果腹腔镜组有206例患者完成胃癌D2根治术，4例（1．9％）中转开腹。与开腹组相比。腹腔镜组患者术中出血量更少（208±38）mltL（300±52）ml，P〈0．05]，术后胃肠功能恢复更快（2．9±0．7）d比（3．9±1．8）d，P〈0．05]，术后住院时间更短（12．8±6．2）d比（15．6±6．8）d，P〈0．05]，但手术时间长（258±42）min比（193±30）min，P〈0．05]。腹腔镜组和开腹组患者淋巴结清扫数目分别为（20．5±1．9）枚／例和（25．8±1．5）枚／例，术后并发症发生率分别为8．1％（17／201）比8．5％（15／180）．差异均无统计学意义（均P〉0．05）。两组患者术后复发转移率分别为2．9％（6／210）比2．8％（5／180），3年生存率分别为35．6％和37．8％，差异也均无统计学意义（均P〉0．05）。结论腹腔镜下胃癌根治术安全、可行，与开腹手术具有相当的淋巴结清扫范围和远期生存。

Laparoscopic versus open surgery for D2 gastrectomy in advanced gastric cancer

Objective To investigate the safety and feasibility of laparoscopic D2 gastrectomy for advanced gastric cancer. Methods The clinical data of 210 cases of laparoscopic gastrectomy and 180 cases of open gastrectomy for radical （D2） gastrectomy from May 2007 to Dec 2010 were analyzed retrospectively. Results A total of 206 cases underwent laparoscopic-assisted surgery with 4 conversions. Compared to the open group, the laparoscopic group was associated with less bleeding （208±38） ml vs. （300±52） ml, P〈0.05 ], quicker postoperative recovery of bowel function （2.9±0.7） d vs. （3.9± 1.8） d, P〈0.05 ], shorter postoperative length of hospital stay （12.8＋6.2） d vs. （15.6±6.8） d, P〈0.05], longer operative time （258±42） rain vs. （193±30） rain, P〈0.05]. The number of lymph node harvested was 20.5±1.9 in the laparoscopic group and 25.8±1.5 in the open group, and the postoperative complication rate was 8.1% （17/201） vs. 8.5% （15/180）, and differences were not statistically significant （both P〉0.05）. The recurrence rate was 2.9%（6/210） and 2.8%（5/180）, and the 3-year overall survival rate was 35.6% and 37.8%, the differences were not statistically significant （both P〉0.05）. Conclusions Laparoscopic radical gastrectomy for gastric cancer is safe and effective, which can reach the same range of lymph node dissection as open gastric cancer surgery and similar survival rate.