胃癌腹腔镜辅助手术与开放手术临床疗效回顾性配对研究

目的:评价腹腔镜辅助手术应用于胃癌治疗是否具有与传统开腹手术相同的安全性及可靠性。方法:回顾性研究我院自2010年1月至2015年12月716例确诊为胃癌且行根治性手术治疗的患者。采用1∶1配对设计，最终获得行腹腔镜辅助手术和开腹手术各116例纳入本研究。对比两种手术方式在近期疗效及远期疗效方面的差异。结果:术中出血量腹腔镜组为（115.8±58.2） ml，开腹组为（185.9±165.4） ml；首次下床活动时间腹腔镜组为（2.4±0.7）天，开腹组为（3.3±1.1）天；术后肛门排气时间腹腔镜组为（3.8±1.5）天，开腹组为（4.4±1.7 ）天；术后流质饮食时间腹腔镜组为（3.9±1.5）天，开腹组为（4.7±2.3）天，以上差异均有统计学意义(P＜0.05)。腹腔镜组术中平均清扫淋巴结（24.7±12.1）枚，开腹组为（24.3±10.2）枚；术中淋巴结清扫及术后并发症方面，两组差异均无统计学意义(P＞0.05)。远期临床疗效显示，进展期胃癌患者术后3年的累积生存率腔镜组与开腹组为79.0% vs 75.8%，差异无统计学意义(P=0.236)。结论:对于胃癌患者采用腹腔镜辅助手术方式近期疗效优于开放手术,且该手术方法具有一定的安全可靠性,两者远期临床疗效相似。

A retrospective and matched control study on the clinical efficacy of laparoscopic and open surgery in gastric cancer

Objective:To evaluate the safety and reliability of laparoscopic surgery for gastric cancer and compared it with conventional surgery(open gastrectomy).Methods:A retrospective study of 716 patients from 2010.01 to 2015.12 with gastric cancer who underwent radical surgery was made.Using 1∶1 pairing design,332 cases were included and laparoscopic group and open group were 116 cases respectively.The difference of the quality of operation,postoperative recovery time,postoperative complications and survival rate between the groups were compared.Results:The blood loss of laparoscopic surgery group was (115.8±58.2) ml,and that of the open group was (185.9±165.4) ml.The first ambulation time of laparoscopic surgery group was (2.4±0.7) d,and that of the open group was (3.3±1.1) d.The postoperative anal exhaust time of laparoscopic surgery group was (3.8±1.5) d,and that of the open group was (4.4±1.7) d.The postoperative fluid diet time of laparoscopic surgery group was (3.9±1.5) d,and that of the open group was (4.7±2.3) d.All differences had statistical significance(P＜0.05).There was no statistical significance(P＞0.05) on mean lymph node dissection of laparoscopic surgery group (24.7±12.1) and open group (24.3±10.2).Meanwhile,there was no statistical difference between the two groups in postoperative complications(P＞0.05).The long-term clinical results showed that the overall survival rate of the patients with advanced gastric cancer after 3 years in laparoscopic surgery group and open group were 79.0% and 75.8%,and there was no significant difference(P=0.236).Conclusion:For patients with gastric cancer,the effect of laparoscopic assisted surgery is better than that of open surgery,the operation is safe and reliable.The long-term clinical efficacy is similar.