腹腔镜远端胃癌D2淋巴结清扫术可行性分析

目的：探讨腹腔镜辅助胃癌D：淋巴结清扫术的安全性及可行性。方法：回顾分析2010年1月至2012年6月为363例患者行腹腔镜远端胃癌耽根治术（腹腔镜组）的临床资料，并与2008年1月至2010年1月412例开放远端胃癌D：根治术（开腹组）进行对比分析。结果：两组患者清扫淋巴结数量、近端切缘距肿瘤距离、远端切缘距肿瘤距离、手术时间、住院时间差异无统计学意义（P〉0．05）；但腹腔镜组术中出血量优于开腹组（P〈0．05）。腹腔镜组术后随访2—27个月，无一例腹壁切口肿瘤种植及复发。结论：腹腔镜胃癌D，根治术治疗进展期胃癌可达到与开放手术相同的肿瘤根治效果，是安全、可行的：较开放手术出血少、康复快，是治疗进展期胃癌的有效术式。

The feasibility of laparoscopic D2 lymphadenectomy for distal gastric cancer

Objective：To discuss the safety and feasibility of laparoscopic-assisted D2 lymphadenectomy for gastric cancer. Methods ：The clinical data of 363 gastric cancer patients （laparoscopic group） who underwent laparoscopie D2 radical resection for dis- tal gastric cancer from Jan. 2010 to Jun. 2012 were retrospectively analyzed, and compared with the data of 412 patients （open group） who underwent open D2 radical resection for distal gastric cancer from Jan. 2008 to Jan. 2010. Results：There were not differences be- tween the laparoseopie group and open group in the number of removed lymph nodes （48.3 ± 31.5 ） vs. （28.5 ± 12.5 ） ] ,the distance from proximal （4.89 ±2.49） cm vs. （4.05 ± 1.77） cm]/distal cut edge （6.95 ± 3.53） cm vs. （7.28±4.67）cm] to tumor edge,operative time （217.5±27.5） rain vs. （ 195±15 ） min] and hospital stay （9.5 ±2.5 ） d vs. （ 11.5±3.5 ） d]. But the bleeding volume during operation in laparoscopic group （115 ± 55 ） ml] was much less than that in the open group （420±330） ml] （ P 〈 0.05 ）. Patients in laparoscopic group were followed up for 2-27 months, no relapse and no tumor implantation at abdominal inci- sion were found. Conclusions：Laparoscopic D2 radical resection for advanced gastric cancer is safe, feasible and effective, has the same effect with open operation, less blood loss and quicker recovery compared with open surgery.