[1]李敏哲,沈荐*,杜燕夫,等.进展期胃癌腹腔镜辅助与开腹全胃D2根治术临床疗效的比较[J].中国微创外科杂志,2017,17(07):589-593.
　Li Minzhe,Shen Jian,Du Yanfu,et al.Comparison of Laparoscopy-assisted Versus Open Radical Total Gastrectomy with D2 Lymph Node Dissection for Advanced Gastric Cancer[J].Chinese Journal of Minimally Invasive Surgery,2017,17(07):589-593.
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进展期胃癌腹腔镜辅助与开腹全胃D2根治术临床疗效的比较()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
17
期数:
2017年07期
页码:
589-593
栏目:
临床论著
出版日期:
2017-07-20

文章信息/Info

Title:
Comparison of Laparoscopy-assisted Versus Open Radical Total Gastrectomy with D2 Lymph Node Dissection for Advanced Gastric Cancer
作者:
李敏哲; 沈荐*; 杜燕夫; 谢德红; 渠浩; 张峪东
首都医科大学附属北京朝阳医院普外科，北京100020
Author(s):
Li Minzhe;  Shen Jian;  Du Yanfu;  et al.
Department of General Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing 100020, China
关键词:
胃癌; 进展期; 全胃切除术; 腹腔镜; 淋巴结清扫
Keywords:
Gastric cancer; Advanced stage; Total gastrectomy; Laparoscopy; Lymph node dissection
文献标志码:
A
摘要:
目的探讨腹腔镜辅助全胃D2根治术治疗进展期胃癌的应用价值。方法回顾性分析我科2012年2月~2015年7月83例进展期胃癌行全胃D2根治术的临床资料，其中腹腔镜辅助胃癌根治术40例（腔镜组），开腹胃癌根治术43例（开腹组）。比较2组围术期情况、术后病理和术后生存情况。结果腔镜组3例（7.5%）中转开腹。腔镜组手术时间明显长于开腹组［(266.0±36.3) min vs. (226.0±28.5) min, t=5.602, P=0.000］，术中出血量明显少于开腹组［(156.2±55.7) ml vs. (261.6±87.2) ml, t=-6.609, P=0.000］，术后肠功能恢复时间［(3.1±1.1) d vs. (3.7±1.5) d, t=-2.070, P=0.042］和住院时间［(14.5±3.9) d vs. (16.0±2.6) d, t=-2.135, P=0.036］明显短于开腹组。2组术中输血率差异无显著性［60.0% (24/40) vs. 65.1%(28/43), χ2=0.232, P=0.630］。2组术后并发症发生率差异无显著性［350%(14/40) vs. 44.2%(19/43), χ2=0.730, P=0.393］。2组所有病例均为R0切除，淋巴结清扫数目［(24.9±6.0)枚 vs.(26.3±5.1)枚, t=-1.163, P=0.248］、淋巴结转移率［85.0%(34/40) vs. 86.0%(37/43), χ2=0.018，P=0.892］、阳性淋巴结数目［(5.8±3.7)枚 vs.(6.2±3.1)枚, t=-0.452, P=0.653］、肿瘤TNM分期（χ2=0673，P=0.714）均无显著性差异。2组生存率无显著性差异(log-rank检验， χ2=0.774， P=0.379)。结论与传统开腹手术相比，腹腔镜辅助全胃D2根治术治疗进展期胃癌安全可行，手术创伤小、术后恢复快，且胃周淋巴结清扫效果同开腹手术一致，术后总体生存率不低于开腹手术。
Abstract:
ObjectiveTo investigate the clinical value of laparoscopy-assisted radical total gastrectomy with D2 lymph node dissection for advanced gastric cancer.MethodsClinical data of 83 cases of radical total gastrectomy with D2 lymph node dissection for advanced gastric cancer from February 2012 to July 2015 in our hospital were analyzed retrospectively. Forty cases receiving laparoscopy-assisted radical total gastrectomy were defined as laparoscopy group, while 43 cases receiving open radical total gastrectomy were defined as open group. The condition during peri-operation period, postoperative pathology and survival were compared between the two groups. ResultsIn the laparoscopy group, there were 3 patients (7.5%) converted to open surgery. The laparoscopy group had significant better results than the control group in the operation time ［(266.0±36.3) min vs. (226.0±28.5) min, t=5602, P=0.000］, the bleeding during the operation ［(156.2±55.7) ml vs. (261.6±87.2) ml, t=-6.609, P=0.000］, postoperative exhaust time［(3.1±1.1) d vs. (3.7±1.5) d, t=-2.070, P=0.042］, and postoperative hospital stay ［(14.5±3.9) d vs. (16.0±2.6) d, t=-2.135, P=0.036］. There were no significant differences in blood transfusion during the operation (χ2=0.232, P=0.630) and the postoperative complications between the two groups (χ2=0730, P=0.393). Analysis of postoperative pathology found all cases of R0 resection in both groups. There were no significant differences in the number of retrieved lymph nodes ［(24.9±6.0) vs. (26.3±5.1), t=-1.163, P=0.248］, lymph node metastasis rate (χ2=0.018，P=0.892), the number of positive lymph nodes ［(5.8±3.7) vs. (6.2±3.1), t=-0.452, P=0653］, and TNM stages (χ2=0.673, P=0714) between the two groups. The two groups had no significant difference in cumulative survival rate (χ2=0.774, P=0.379).ConclusionLaparoscopy-assisted radical total gastrectomy with D2 lymph node dissection for advanced gastric cancer is a safe and feasible procedure with minimal invasion and quicker recovery, and it is comparable with open total gastrectomy in lymph node dissection and overall survival.

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备注/Memo

备注/Memo:
*通讯作者，E-mail:410078@163.com
更新日期/Last Update: 2017-09-21