[腹腔镜辅助与开放远端胃癌根治术治疗进展期胃癌的对比研究]

[A comparative study of laparoscopic-assisted and open distal gastrectomy for advanced gastric cancer].

作者信息

Ye Min-feng, Tao Feng, Xu Guan-gen, Xu Guo-quan, Jing Yuan-ming, Lü Jie-qing, Sun Ai-jing

机构信息

Department of Gastrointestinal Surgery, Shaoxing People's Hospital & Shaoxing Hospital of Zhejiang University, Shaoxing 312000, China.

出版信息

Zhonghua Wai Ke Za Zhi. 2013 May 1;51(5):396-9.

PMID:23958159

Abstract

OBJECTIVE

To evaluate the safety, feasibility and the long-term outcomes of laparoscopy-assisted gastrectomy (LAG) for advanced gastric cancer (AGC).

METHODS

The clinical and follow-up data of 46 cases after LAG from June 2008 to December 2009 were analyzed, and compared with 85 cases after conventional open gastrectomy (OG) for advanced gastric cancer at the same period at our hospital. The surgical safety, postoperative recovery, complications, radical degree, survival rate were compared.

RESULT

As compared with OG group, operation time was longer in LATG group ((274 ± 78) min vs. ( 217 ± 41) min, t = 4.635, P = 0.000). Estimated blood loss in the LAG group ((254 ± 112) ml) was significantly less than in the OG group (t = 3.942, P = 0.000). Time to ambulation ((63 ± 16) hours), first flatus ((77 ± 20) hours), resumed liquid diet ((88 ± 15) hours), duration of analgesic medication ((53 ± 20) hours) and postoperative hospital stay ((11.1 ± 4.6) days) were significantly shorter in the LAG group (t = 5.549, 6.508, 9.436, 9.464 and 2.980 respectively, all P < 0.01). The distance of the proximal and distal resection margin were (5.7 ± 1.4) cm and (3.9 ± 1.5) cm in LAG group, (5.8 ± 1.1) cm and (4.7 ± 1.5) cm in OG group respectively, but the difference was not significant. The number of lymph node dissections was also similar, (30.5 ± 10.4) in LAG group and (32.6 ± 12.3) in OG group (t = 0.960, P = 0.339). The incidence of postoperative complications and mortality rate in LAG group (8.7% and 0 respectively) were also lower than in the OG group, with no statistically significant difference (P > 0.05). The mean follow-up was 31.0 months (range 6-48 months), and the cumulative survival of the 2 groups was similar (χ(2) = 1.594, P = 0.207).

CONCLUSIONS

Laparoscopy-assisted gastrectomy for advanced gastric cancer is not significantly different with open surgery in surgical safety, radical degree, and survival rate. It is less traumatic and of fewer complications.

摘要

目的

评估腹腔镜辅助胃癌切除术（LAG）治疗进展期胃癌（AGC）的安全性、可行性及长期疗效。

方法

分析2008年6月至2009年12月46例行LAG患者的临床及随访资料，并与同期我院85例行传统开腹胃癌切除术（OG）的进展期胃癌患者进行比较。比较手术安全性、术后恢复情况、并发症、根治程度及生存率。

结果

与OG组相比，LATG组手术时间更长（（274±78）分钟 vs.（217±41）分钟，t = 4.635，P = 0.000）。LAG组估计失血量（（254±112）ml）明显少于OG组（t = 3.942，P = 0.000）。LAG组患者下床活动时间（（63±16）小时）、首次排气时间（（77±20）小时）、恢复流食时间（（88±15）小时）、镇痛药物使用时间（（53±20）小时）及术后住院时间（（11.1±4.6）天）均明显短于OG组（分别为t = 5.549、6.508、9.436、9.464及2.980，均P < 0.01）。LAG组近端和远端切缘距离分别为（5.7±1.4）cm和（3.9±1.5）cm，OG组分别为（5.8±1.1）cm和（4.7±1.5）cm，但差异无统计学意义。淋巴结清扫数目也相似，LAG组为（30.5±10.4）枚，OG组为（32.6±12.3）枚（t = 0.960，P = 0.339）。LAG组术后并发症发生率及死亡率（分别为8.7%和0）也低于OG组，但差异无统计学意义（P > 0.05）。平均随访31.0个月（范围6 - 48个月），两组累积生存率相似（χ(2)=1.594，P = 0.207）。