腹腔镜与开腹行胃癌D2根治术的对照研究及中期随访报告

目的 探讨腹腔镜胃癌D2根治术的可行性及临床疗效.方法 回顾性分析我院2005年12月～ 2010年9月行腹腔镜胃癌D2根治手术160例,同期开腹胃癌D2根治术（相同分期）180例的病例资料,比较2组淋巴结清扫数目及术后恢复、并发症、病死率及生存率等.结果 （1）腹腔镜组清扫淋巴结（26.3±12.9）枚,与开腹组（26.8±11.2）枚比较,差异无显著性（t=-0.393,P=0.694）.（2）与开腹组相比,腹腔镜组术中出血少[（239.1±132.1）ml vs.（296.9±135.6） ml,t=-3.971,P=0.000],术后肛门排气早[（3.6±1.0）d vs.（4.3±0.8）d,t=-7.161,P=0.000],但手术时间长[全胃（215.0±22.6） min vs.（199.3±15.8）min,t=6.155,P=0.000;远端胃（180.0±21.1）min vs.（156.8±9.9）min,t=6.931,P=0.000],早期并发症发生率高[18.8％ （30/160） vs.9.4％（17/180）,Х^2=6.157,P=0.013].（3）腹腔镜组与开腹组3年生存率差异无显著性（48.1％ vs.54.9％,log-rank Х^2=1.531,P=0.216）.结论 腹腔镜胃癌D2根治淋巴结清扫是可行的,清扫淋巴结数目和开腹手术类似,能够符合肿瘤根治原则.与开腹相比,腹腔镜组具有安全、术后恢复快等微创优点.2组3年生存率差异无显著性,中期疗效肯定,远期疗效有待进一步观察.

A Comparative Study and Medium-term Follow-up Report of Laparoscopy-assisted and Open Surgery on Radical Gastrectomy with D2 Dissection for Gastric Cancer

Objective To explore the feasibility and clinical outcome of laparoscopy-assisted gastrectomy with D2 dissection.Methods We retrospectively reviewed the clinical data of 160 cases undergoing laparoscopic gastrectomy and 180 cases undergoing open gastrectomy with D2 lymph node dissection in our hospital from December 2005 to September 2010.The number of lymph nodes dissected,postoperative recovery,complications,mortality and survival rate of the two groups were analyzed.Results No significant difference was found in the number of lymph nodes resected between the two groups （laparoscopy-assisted group and open group：26.3 ± 12.9 vs.26.8 ± 11.2,t =-0.393,P =0.694）.Compared with open group,the laparoscopy-assisted group showed significantly less intraoperative blood loss [（239.1 ± 132.1） ml vs.（296.9 ± 135.6） ml,t =-3.971,P =0.000],quicker recovery of gastrointestinal function [（3.6±1.0） d vs.（4.3 ±0.8） d,t=-7.161,P=0.000],longer operative time [total gastrectomy （215.0 ±22.6） min vs.（199.3 ± 15.8） min,t =6.155,P =0.000; distal gastrectomy （180.0 ± 21.1） min vs.（156.8 ± 9.9） min,t =6.931,P =0.000],and higher rate of postoperative complications in the early period of postoperation [18.8% （30/160） vs.9.4% （17/180）,Х^2 =6.157,P =0.013].No significant difference was found in the 3-year survival rate between the two groups （laparoscopy-assisted group and open group：48.1% vs.54.9%,log-rank Х^2 =1.531,P =0.216）.Conclusions Laparoscopic gastrectomy with D2 lymphadenectomy for gastric cancer is feasible and safe.No statistical difference is found in the number of resected lymph nodes between laparoscopic and open gastrectomy.Compared to open surgery,laparoscopic gastrectomy is safer and has quicker postoperative recovery.There is no significant difference in the 3-year survival rate between the laparoscopic gastrectomy and the open group.The medium-term outcome has been confirmed while the long-term outcome requires further research.