腹腔镜辅助胃癌根治术治疗早期和进展期胃癌的临床研究

徐本文，杨晨曦，周业庭

江苏省沭阳县人民医院普外科，江苏沭阳223600

[摘要]目的探讨腹腔镜辅助胃癌根治性切除术的临床可行性和效果。方法回顾性分析该院胃肠外科2012年1月—2014 年10月收治的91例胃癌根治性手术患者的临床资料，根据手术方式分为腹腔镜组（采用腹腔镜辅助手术46例）、开腹组（采用传统开腹手术治疗45例），比较两组患者的手术情况及术后并发症的发生情况差异。结果腹腔镜组的手术时间（192.4±16.6）min显著长于开腹组（P<0.05）；腹腔镜组的切口长度显著小于开腹组（P<0.05）；腹腔镜组的术中出血量（279.4± 46.3）mL显著小于开腹组（P<0.05）；腹腔镜组的术后肛门排气时间、下床活动时间、术后住院时间显著的短于开腹组患者（P<0.05）；开腹组术中共清扫淋巴结（18.1±2.2）枚，与腹腔镜组的（17.2±2.5）枚相当（P>0.05）。两组患者91例患者均顺利完成全部手术过程，腹腔镜组无一例中转开腹手术的患者；腹腔镜组术后并发症发生率为3.33%，明显低于开腹组的23.33%，两组患者间差异有统计学意义（P<0.05）。结论腹腔镜辅助胃癌根治术可彻底清扫引流淋巴结，减少术中出血及术后并发症，临床疗效肯定。

[关键词]腹腔镜辅助；胃癌根治性切除术；临床可行性；开腹手术

[中图分类号]R4

[文献标识码]A

[文章编号]1674-0742（2015）10（a）－0092-04

[作者简介]徐本文（1964.10-）,男,江苏沭阳人，本科，副主任医师，研究方向：临床普通外科腹腔镜根治术方面。Clinical Research of Laparoscope-assisted Radical Gastrectomy for Early and Advanced Gastric Cancer

Abstract[]Objective To study the clinical feasibility and efficacy of laparoscope-assisted radical gastrectomy for early and advanced gastric cancer.Methods A retrospective analysis was done on the clinical data of 91 patients with gastric cancer admitted to the Department of Gastrointestinal Surgery from January 2012 and October 2014.According to the treatment regime they were divided into the laparoscopy group in which laparoscope-assisted radical gastrectomy was performed for the 46 patients and the laparotomy group in which the 45 patients underwent traditional laparotomy.The indicators of the operation and postoperative complications were compared between the two groups.Results The operation duration was (192.4±16.6) min in the laparoscopy group, significant less than that in the laparoromy group (P<0.05); the incision length was significantly less in the laparoscopy group than in the laparoromy group (P<0.05); the blood loss was（279.4±46.3）mL, in the laparoscopy group, significant less than that in the laparoromy group (P<0.05).In terms of exhaust time, out-of-bed activity time, lengthy of hospital stay, the laparoscopy group was significantly shorter than the laparotomy group (P<0.05).The number of lymph node dissection was（18.1±2.2）in laparotomy group, similar with that of the laparoscopy group,（17.2±2.5）, P>0.05.All the 91 patients were treated successfully without conversion from laparoscope-assisted radical gastrectomy to laparotomy surgery.The postoperative complication rate (3.33% vs 23.33%) was significantly lower in the laparoscopy group than in the laparoromy group with statistical difference (P< 0.05).Conclusion laparoscope-assisted radical gastrectomy can dissect draining lymph nodes and reduce blood loss and postoperative complication with exact effect.

收稿日期：（2015-07-02）

XU Ben-wen, YANG Chen-xi, ZHOU Ye-ting

Department of General Surgery, Shuayang People's Hospital, Shuyang, Jiangsu Province, 223600 China

[Key words]Laparoscopic assisted surgery; Radical gastrectomy; Clinical feasibility; Open operation

早期胃癌患者多无明显的不适，少数患者可有恶心、呕吐或上腹部不适等轻微症状，胃癌根治性手术效果佳，患者5年生存率高。进展期胃癌患者常见的临床症状为上腹部持续性疼痛和体重减轻，随着病情的进展，患者可有贫血、恶病质症状，根治性手术仍是该期患者的根本手术，但其5年生存率较早期明显下降[1]。腹腔镜辅助根治性手术治疗胃癌至今已有十余年的历史，以手术切口小，术中出血量少和术后并发症发生率低的显著优势成为胃癌治疗的常用措施[2]。……