腹腔镜辅助与开腹远端胃癌根治术的病例对照研究。
Case-matched comparison of laparoscopy-assisted and open distal gastrectomy for gastric cancer.
机构信息
Department of Gastrointestinal Surgery, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing 312000, Zhejiang Province, China.
出版信息
World J Gastroenterol. 2013 Jun 21;19(23):3672-7. doi: 10.3748/wjg.v19.i23.3672.
AIM
To compare short- and long-term outcomes of laparoscopy-assisted and open distal gastrectomy for gastric cancer.
METHODS
A retrospective study was performed by comparing the outcomes of 54 patients who underwent laparoscopy-assisted distal gastrectomy (LADG) with those of 54 patients who underwent open distal gastrectomy (ODG) between October 2004 and October 2007. The patients' demographic data (age and gender), date of surgery, extent of lymphadenectomy, and differentiation and tumor-node-metastasis stage of the tumor were examined. The operative time, intraoperative blood loss, postoperative recovery, complications, pathological findings, and follow-up data were compared between the two groups.
RESULTS
The mean operative time was significantly longer in the LADG group than in the ODG group (259.3 ± 46.2 min vs 199.8 ± 40.85 min; P < 0.05), whereas intraoperative blood loss and postoperative complications were significantly lower (160.2 ± 85.9 mL vs 257.8 ± 151.0 mL; 13.0% vs 24.1%, respectively, P < 0.05). In addition, the time to first flatus, time to initiate oral intake, and postoperative hospital stay were significantly shorter in the LADG group than in the ODG group (3.9 ± 1.4 d vs 4.4 ± 1.5 d; 4.6 ± 1.2 d vs 5.6 ± 2.1 d; and 9.5 ± 2.7 d vs 11.1 ± 4.1 d, respectively; P < 0.05). There was no significant difference between the LADG group and ODG group with regard to the number of harvested lymph nodes. The median follow-up was 60 mo (range, 5-97 mo). The 1-, 3-, and 5-year disease-free survival rates were 94.3%, 90.2%, and 76.7%, respectively, in the LADG group and 89.5%, 84.7%, and 82.3%, respectively, in the ODG group. The 1-, 3-, and 5-year overall survival rates were 98.0%, 91.9%, and 81.1%, respectively, in the LADG group and 91.5%, 86.9%, and 82.1%, respectively, in the ODG group. There was no significant difference between the two groups with regard to the survival rate.
CONCLUSION
LADG is suitable and minimally invasive for treating distal gastric cancer and can achieve similar long-term results to ODG.
目的
比较腹腔镜辅助与开腹远端胃癌根治术的近期和远期疗效。
方法
回顾性分析 2004 年 10 月至 2007 年 10 月 54 例行腹腔镜辅助远端胃癌根治术（LADG）患者与同期 54 例行开腹远端胃癌根治术（ODG）患者的临床资料，比较两组患者的一般资料（年龄、性别）、手术时间、淋巴结清扫范围、肿瘤分化程度和肿瘤-淋巴结-转移分期，观察并比较两组患者的术中出血量、术后恢复情况、并发症、病理结果及随访资料。
结果
LADG 组患者的手术时间明显长于 ODG 组（259.3±46.2 min 比 199.8±40.85 min；P<0.05），术中出血量和术后并发症发生率明显低于 ODG 组（160.2±85.9 mL 比 257.8±151.0 mL；13.0%比 24.1%，P<0.05）。此外，LADG 组患者首次肛门排气时间、开始经口进食时间及术后住院时间均明显短于 ODG 组（3.9±1.4 d 比 4.4±1.5 d；4.6±1.2 d 比 5.6±2.1 d；9.5±2.7 d 比 11.1±4.1 d，P<0.05）。两组患者的淋巴结清扫数目差异无统计学意义。中位随访时间为 60 个月（5~97 个月）。LADG 组患者的 1、3、5 年无病生存率分别为 94.3%、90.2%、76.7%，ODG 组患者分别为 89.5%、84.7%、82.3%；LADG 组患者的 1、3、5 年总生存率分别为 98.0%、91.9%、81.1%，ODG 组患者分别为 91.5%、86.9%、82.1%。两组患者的生存率差异无统计学意义。
结论
LADG 治疗远端胃癌是安全可行的，微创优势明显，且与 ODG 相比具有相似的远期疗效。
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