Li Zhi-Xiong, Xu Yan-Chang, Lin Wen-Lin, Chen Jian, Wu Hai-Yan
No.1 Section of the Department of Surgical Oncology, the First Hospital of Putian, Putain, China.
J BUON. 2013 Jul-Sep;18(3):689-94.
To explore the feasibility and short-term effect of laparoscopy-assisted D2 radical gastrectomy for advanced gastric cancer.
A total of 239 patients with advanced gastric cancer underwent D2 radical gastrectomy between March 2009 and June 2011, from which 106 patients underwent laparoscopic surgery (laparoscopy group) and 133 patients underwent open surgery (open surgery group). The intraoperative and postoperative condition, number of lymph node removed, complications and mortality rates between the two groups were compared.
The operation time (268±51 min) and the number of lymph node removed (29.1+6.1) in the laparoscopy group were comparable with the operation time (268±49 min) and the number of lymph node removed (30.2±7.0) in the open surgery group, while there were significant differences in the intraoperative bleeding (134±66 vs 289±139 ml), intraoperative blood infusion cases (5 vs 19), time to first postoperative flatus (3.4±0.9 vs 5.0±1.4 days), time to first taking liquid food (7.3±1.3 vs 8.1±1.4 days) and postoperative hospital stay (12.8±2.6 vs 14.5±3.1 days) between the two groups (p<0.05). These results favored the laparoscopy group. The incidence of postoperative complications in the laparoscopy and open surgery group were 14.1 and 24.8, respectively (p<0.05). Compared with the open surgery, the laparoscopic surgery significantly reduced the incidence of pulmonary infection (p<0.05). There was no significant difference in the postoperative short-term survival rate between the two groups (p>0.05).
Laparoscopy-assisted D2 gastrectomy for advanced gastric cancer is advantageous in terms of safety and feasibility, rapid postoperative recovery and few complications. Both groups gave comparable results in terms of lymph node dissection and short-term survival.
探讨腹腔镜辅助D2根治性胃癌切除术治疗进展期胃癌的可行性及短期疗效。
2009年3月至2011年6月期间，共有239例进展期胃癌患者接受了D2根治性胃切除术，其中106例患者接受了腹腔镜手术（腹腔镜组），133例患者接受了开放手术（开放手术组）。比较两组患者的术中及术后情况、淋巴结清扫数量、并发症及死亡率。
腹腔镜组的手术时间（268±51分钟）和淋巴结清扫数量（29.1+6.1）与开放手术组的手术时间（268±49分钟）和淋巴结清扫数量（30.2±7.0）相当，但两组在术中出血量（134±66 vs 289±139毫升）、术中输血例数（5 vs 19）、首次排气时间（3.4±0.9 vs 5.0±1.4天）、首次进流食时间（7.3±1.3 vs 8.1±1.4天）及术后住院时间（12.8±2.6 vs 14.5±3.1天）方面存在显著差异（p<0.05）。这些结果支持腹腔镜组。腹腔镜组和开放手术组的术后并发症发生率分别为14.1%和24.8%（p<0.05）。与开放手术相比，腹腔镜手术显著降低了肺部感染的发生率（p<0.05）。两组术后短期生存率无显著差异（p>0.05）。
腹腔镜辅助D2根治性胃癌切除术治疗进展期胃癌在安全性和可行性、术后恢复快及并发症少方面具有优势。两组在淋巴结清扫和短期生存方面结果相当。
