腹腔镜全胃D2根治术与开腹手术治疗胃上部癌的比较研究

目的探讨腹腔镜全胃D2根治术治疗胃上部癌的安全性、肿瘤根治性以及术后早期疗效。方法接受腹腔镜全胃D2根治术（腹腔镜手术组）的122例胃上部癌患者为研究对象，同期采用传统开腹全胃D2根治术（传统开腹组）的132例为对照。两组性别、年龄、肿瘤位置、病理类型和TNM分期差异均无统计学意义。结果传统开腹组及腹腔镜手术组在手术时间（235．78±31．56）min比（256．43±54．08）min]、出血量（326．69±89．73）ml比（158．31±62．98）m1]、切口长度（16．53±2．34）cm比（5．51±1．15）cm]、胃肠道恢复时间（4．22±0．91）d比（3．31±0．83）d]、术后首次进食流质时间（5．78±0．95）d比（5．56±0．78）d]和术后住院时间【（12．62±2．89）d比（11．18±1.78）d]差异有统计学意义（均P〈0．001）。两组的淋巴结清除数目及并发症差异均无统计学意义（均P〉0．05）。结论腹腔镜全胃D2根治术是一种安全、微创的手术方法。腹腔镜全胃D2根治术与传统开腹全胃D2根治术可获得相同的淋巴结清扫范围及良好的早期疗效，但较开腹手术有创伤小、术后恢复快等优势。

Comparative study of laparoscopic gastrectomy D2 radical surgery and open gastrectomy for upper stomach cancer

Objective To evaluate the safety, tumor radical and early postoperative efficacy through comparison of laparoscopic gastric D2 radical surgery with traditional open gastric D2 radical surgery. Methods 254 patients with upper stomach cancer underwent surgery were selected, 132 cases using conventional open gastrectomy （the traditional laparotomy group）, 122 patients underwent laparoseopic radical gastrectomy （laparoscopic surgery group）. Laparoseopie surgery group with traditional open surgery group had no statistically significant differences in gender, age, tumor location, histological type and TNM staging. Results Open surgery group and laparoseopic surgery group had statistically significant differences in operative time （235.78±31.56） min, （256.43±54.08） min, P 〈 0.001], blood loss （326.69±89.73） ml, （158.31±62.98） ml, P 〈 0.001], incision length （16.53±2.34） cm, （5.51±1.15） cm, P 〈 0.001], gastrointestinal recovery time （4.22±0.91） d, （3.31±0.83） d, P 〈 0.001], first time eating liquid （5.78±0.95） d, （5.56±0.78） d, P 〈 0.001] and postoperative hospital stay （12.62±2.89） d, （11.18±1.78） d, P 〈 0.001]. The total number of lymph node dissection and complications was not statistically significant. Conduslons Laparoscopic gastric D2 radical surgery is a safe, minimally invasive surgical method. Laparoscopic gastric D2 radical surgery has the same lymph node dissection and good early outcome compared with the traditional gastric D2 radical surgery, but postoperative recovery fast and less invasive.