内镜黏膜下剥离术后复发胃癌行腹腔镜与开腹根治术的临床对比

目的: 评价内镜黏膜下剥离术(endoscopic submucosal dissection，ESD)术后复发胃癌行腹腔镜下胃癌根治术的安全性和优越性。方法: 回顾性分析ESD术后复发胃癌行胃癌根治性切除术的61例患者的临床资料。其中，41例行腹腔镜辅助下胃癌根治术(腹腔镜组)，20例行开腹胃癌根治术(开腹组)。统计并对比分析两组患者的一般资料、手术相关指标以及术后恢复的相关资料。结果：两组患者的年龄、性别、肿瘤距切缘长度、清扫淋巴结数目、病理分期，术中损伤情况以及术后并发症等差异均无统计学意义(P均>0.05)。与开腹组比较，腹腔镜组手术时间长，住院费用高(P均<0.01)，但C-反应蛋白低、手术切口长度小、术中出血量少以及术后镇痛药物使用例数少、首次通气时间早、胃肠减压拔除时间早、首次进流质饮食时间早、腹腔引流管拔除时间早及住院天数短(P均<0.05)。结论：腹腔镜胃癌根治术治疗ESD术后复发胃癌安全、有效，与开腹胃癌根治术比较，具有明显的创伤小，出血量少，恢复快等优势。

Clinical comparison of laparoscopy assisted radical gastrectomy and open radical gastrectomy in gastric cancer after endoscopic submucosal dissection

Objective: To evaluate the safety and superiority of laparoscopy-assisted radical gastrectomy (LARG) for gastric cancer after endoscopic submucosal dissection (ESD). Methods: A total of 61 patients who underwent laparoscopic assisted radical gastrectomy (LARG group, n=41) or open radical gastrectomy(open group, n=20) for gastric cancer after ESD were retrospectively analyzed. The general data, indicators related to the operation and postoperative recovery of relevant information of two group patients were analyzed. Results: There were no differences in the age, gender, length of the tumor to the cut edge, number of cleaning lymph nodes, pathological staging, intraoperative injury, postoperative complications between LARG group and open group (both P>0.05). Compared with the open group, LARG group had longer operative time and higher expenditure (both P<0.01), but lower C-reactive protein, shorter scar,less blood loss,less postoperative pain-killers, shorter time for first flatus, and for unplugging gastrointestinal decompression, shorter time to tolerance of soft diet, and for unplugging the peritoneal drainage tube and faster postoperative recovery(both P<0.05). Conclusion: Laparoscopic-assisted radical gastrectomy is a feasible, safe, efficient and minimal invasive procedure for gastric cancer therapy after ESD.