摘要
目的 评价腹腔镜远端胃癌D2根治术治疗无浆膜层侵犯的进展期胃癌的可行性、安全性以及术后近期和远期疗效.方法 选取2007年5月至2013年5月间宁波市鄞州第二医院54例无浆膜层侵犯的胃窦癌行腹腔镜辅助D2根治术作为试验组,并按年龄、性别、肿瘤位置、肿瘤分期、消化道重建方式等匹配条件从同期开腹胃癌D2根治术的患者中选取54例作为对照组,比较两组的手术风险、术后恢复和随访结果.结果 两组患者手术均获得成功.试验组和对照组的手术时间分别为（168 ±31） min和（157 ±20） min,差异有统计学意义（t=2.237,P=0.027）;术中出血量分别为（151 ±56） ml和（213±86） ml,差异有统计学意义（t=4.45,P=0）;术后肠功能恢复时间分别为（2.7±0.7）d和（3.4±0.5）d,差异有统计学意义（t=5.4;P=0）;淋巴结清扫数分别为（26.4±4.2）枚和（24.8±5.2）枚,差异无统计学意义（t=1.769,P=0.08）.两组的术中并发症发生率均为4％,术后的并发症发生率分别为4％、11％,无围手术期死亡的病例.术后病理分期ⅠB、ⅡA、ⅡB、ⅢA期分别为8、17、24、5例和9、14、23、8例.术后随访108例患者7 -79个月,腹腔镜组共有8例有局部复发或远处转移,肿瘤相关死亡4例;开腹组共有9例局部复发或远处转移,肿瘤相关死亡6例.结论 腹腔镜远端胃癌D2根治术治疗无浆膜层侵犯的进展期胃癌安全可行,具有创伤轻、恢复快等优点,有着较好的近期和远期疗效.
Objective To evaluate the feasibility,safety,post-operative short and long-term outcomes of laparoscopic-assisted D2 radical distal gastrectomy in treating advanced gastric carcinoma without serosal invasion.Method From May 2007 to May 2013,54 cases of advanced gastric antral cancer without serosal invasion underwent laparoscopic-assisted D2 radical distal gastrectomy （laparoscopic group）,54 demographically and pathologically-matched cases undergoing open surgery served as control.The surgical risk,post-operative recovery and follow-up results were compared.Result Surgery was successful in all patients.The mean operation time in laparoscopic group and open group was （168 ± 31） mins and （157 ±20） min respectively,the difference was significant （t =2.237,P =0.027） ; Intra-operative blood loss was （151 ± 56） ml and （213 ± 86） ml （t =4.45,P =0） ; Post-operative intestinal function recovery time was （2.7 ± 0.7） d and （3.4 ± 0.5） d （t =5.4,P =0） ; Lymph node dissection number was （26.4 ± 4.2） and （24.8 ±5.2） （t =1.769,P=0.08）.Post-operative complication rate was 4％ and 11％ （P =0.142）.There was no perioperative mortality in either group.Post-operative pathological stage of Ⅰ B,Ⅱ A,Ⅱ B,ⅢA was 8,17,24,5 cases in laparoscopic group and 9,14,23,8 cases in open surgery group.108 cases were followed up from 7 to 79 months.In laparoscopic group,8 cases had local recurrence or distal mestastasis,and 4 cases died from tumor; In open group,9 cases had local recurrence or distal mestastasis,and 6 cases died from tumor.Conclusions Laparoscopic-assisted D2 radical distal gastrectomy in treating advanced gastric cancer without serosal invasion is feasible,safe and advantageous in minimal invasion and rapid recovery,with good short and long-term outcomes.
出处
《中华普通外科杂志》
CSCD
北大核心
2014年第10期737-739,共3页
Chinese Journal of General Surgery
基金
宁波市科技局社会发展基金资助项目（2010C50013）
关键词
胃肿瘤
腹腔镜
胃切除术
Stomach neoplasms
Laparoscopes
Gastrectomy
