全腹腔镜下远端胃癌根治术治疗高龄胃癌患者的疗效观察

目的:探讨全腹腔镜下远端胃癌根治术治疗高龄胃癌患者的临床疗效。方法:选取2019年1月至2021年12月期间在我院接受腹腔镜下胃癌根治术的高龄胃癌患者（≥70岁）作为研究对象，经倾向性匹配后根据手术方式分为观察组与对照组，其中观察组接受全腹腔镜下远端胃癌根治术（40例），对照组接受腹腔镜辅助远端胃癌根治术（80例）。比较两组患者的手术近期疗效、术后并发症、免疫功能变化、生活质量与生存情况。结果:与对照组相比，观察组患者的术后并发症发生率相近（10% vs 23%，P=0.095），但首次下床时间、首次排气时间与术后住院时间均显著较短，差异具有统计学意义（P＜0.05）。另外，观察组患者术后1周的WBC与CRP水平明显低于对照组，而CD3+、CD4+与CD4+/CD8+水平明显高于对照组。对比两组患者术后6个月的生活质量，观察组的疼痛、便秘评分明显优于对照组，差异具有统计学意义（P＜0.05）。术后随访均未发现肿瘤局部复发病例。结论:与传统的腹腔镜辅助手术相比，全腹腔镜下远端胃癌根治术治疗高龄胃癌患者具有术后恢复快、对免疫功能影响小、并发症少、生活质量高等优点，值得进一步推广应用。

Clinical efficacy of total laparoscopic distal gastrectomy in treatment for elderly gastric cancer patients

Objective:To investigate the clinical efficacy of total laparoscopic distal gastrectomy (DG) in the treatment of elderly gastric cancer (GC) patients.Methods:Elderly GC patients (aged over 70 years) who received laparoscopic distal gastrectomy in our hospital between January 2019 and December 2021 were included.After propensity score-matching,patients were classified into the observation group with total laparoscopic distal gastrectomy (n=40) and the control group with laparoscopic assisted distal gastrectomy(n=80) according to the surgical approaches.The short-term outcomes,postoperative complications,changes in immune function,quality of life (QOL),and survival were compared between the groups.Results:Compared with the control group,patients in the observation group had comparable postoperative morbidity (10% vs 23%,P=0.095),but had significantly shorter time to ambulation,time to first flatus,and postoperative hospital stay (P＜0.05).Moreover,the levels of white blood cells and C-reactive protein were significantly lower and the levels of CD3+,CD4+,and CD4+/CD8+ were significantly higher in the observation group than in the control group.In terms of the QOL,the scores of pain and constipation were significantly better in the observation group than in the control group (P＜0.05).No local recurrence was observed during the follow-up.Conclusion:Compared with the traditional laparoscopic assisted DG,total laparoscopic DG had faster recovery,less impact on the immune function,lower complications,and higher QOL in treating elderly GC patients,which should be further applied in the clinical practice.