腹腔镜辅助胃癌D2根治术治疗老年进展期远端胃癌患者的临床价值及近期预后

目的 探讨腹腔镜辅助胃癌D2根治术治疗老年进展期远端胃癌患者的疗效及近期预后.方法 回顾性分析2014年1月至2017年3月中国科技大学附属第一医院收治的限期行胃癌D2根治术治疗的64例老年进展期远端胃癌患者的临床资料,根据治疗方案不同分为观察组(28例)和对照组(36例).观察组应用腹腔镜辅助胃癌D2根治术治疗,对照组应用常规开腹胃癌D2根治术治疗.比较两组患者的手术时间、术中出血量、术后胃肠排气时间、术后住院时间、淋巴结清扫数等临床指标;比较两组患者切口感染、肺部感染、吻合口瘘、吻合口出血及术后胃瘫等术后并发症的差异.随访3～36个月,比较两组患者术后生存时间及术后肿瘤复发率的差异.结果 观察组的手术时间、术中出血量、术后胃肠排气时间、术后住院时间等临床指标均低于对照组,差异有统计学意义(P<0.05),两组患者淋巴结清扫数差异无统计学意义(P>0.05),两组患者的术后并发症发生率差异无统计学意义(P>0.05).随访3～36个月,术后平均生存时间及术后肿瘤复发率差异无统计学意义(P>0.05).结论 腹腔镜辅助胃癌D2根治术治疗老年进展期远端胃癌患者具有手术时间短、术中出血量少、术后恢复快等优点,近期预后与开腹手术相似.

Clinical effect oflaparoscopic assisted D2 radical surgery on elderly patients with advanced distal gastric cancer and its short-term prognosis

Objective To analyze the clinical effect of laparoscopic assisted D2 radical surgery on elderly patients with advanced distal gastric cancer (ADGC) and the short-term prognosis. Methods Sixty-four patients with ADGC receiving laparoscopic assisted D2 radical surgery from this hospital were selected and divided into two groups according to the operative method, namely, the research group (28 cases, received laparoscopic assisted D2 radical surgery) and the control group (36 cases, received normal intra-abdominal D2 radical surgery). The indexes of clinical efficiency including operation time, operation bleeding volume, gastrointestinal exhaust time, postoperative hospitalization time and number of lymph node dissection were compared between the two groups. And the postoperative complication rates of incision infection, lung infection, anastomotic stoma fistula, anastomotic stoma bleeding and postoperative gastroparesis were compared between two groups. During the follow-up of 3 to 36 months, the indexes of postoperative survival time and recurrence rate were compared between two groups. Results Compared to control group, the indexes of operation time, operation bleeding volume, gastrointestinal exhaust time and postoperative hospitalization time of research group were lower (P<0.05), but the number of lymph node dissection showed no statistically significant difference between the two groups (P>0.05). The postoperative complication rates had no statistically significant difference between the two groups (P>0.05). Followed-up for 3 to 36 months, the indexes of postoperative survival time and recurernce rate had no statistically significant difference between the two groups (P>0.05). Conclusion Laparoscopic assisted D2 radical surgery for ADGC has the advantages of shorter operative time, less intraoperative blood loss and faster postoperative recovery. The short-term prognosis is similar to that of open surgery.