Department of Minimally Invasive Surgery Center, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan Province, China.
Department of Minimally Invasive Surgery Center, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan Province, China.
Am J Surg. 2018 Sep;216(3):528-533. doi: 10.1016/j.amjsurg.2018.05.005.
To compare the results of total laparoscopic distal gastrectomy (TLDG) and laparoscopy-assisted distal gastrectomy (LADG) and explore the safety and feasibility of TLDG.
Data were collected and analyzed from patients underwent TLDG and LADG from January 2009 to December 2011 at our institution.
127 LADG cases and 104 TLDG cases were included and balanced for age, sex, BMI, ASA scores, and CEA level in this study. A decrease in postoperative pain (P < 0.001), wound infection rate (P = 0.013), and hospitalization time after surgery (P < 0.001) was found in the TLDG group. Compared with the LADG group, there was no increase in operative time (P = 0.084), intraoperative blood loss (P = 0.061), or anastomotic fistula rate (P = 0.473). Statistical differences did not exist in recurrence and (or) metastasis (P = 0.204), 5-years disease-free survival (DFS) rate and overall survival (OS) (P = 0.570 and 0.560, respectively).
As long as it follows the surgical principles of malignant tumor, TLDG can achieve the same therapeutic effect as LADG does. TLDG is safe and feasible for gastric cancer patients though further studies are needed.
比较全腹腔镜远端胃切除术（TLDG）和腹腔镜辅助远端胃切除术（LADG）的结果，探讨 TLDG 的安全性和可行性。
本研究收集并分析了 2009 年 1 月至 2011 年 12 月期间在我院行 TLDG 和 LADG 的患者数据。
本研究中，127 例 LADG 病例和 104 例 TLDG 病例在年龄、性别、BMI、ASA 评分和 CEA 水平方面平衡。TLDG 组术后疼痛（P<0.001）、伤口感染率（P=0.013）和术后住院时间（P<0.001）降低。与 LADG 组相比，手术时间（P=0.084）、术中出血量（P=0.061）和吻合口瘘发生率（P=0.473）无增加。复发和（或）转移（P=0.204）、5 年无病生存率（DFS）率和总生存率（OS）（P=0.570 和 0.560）无统计学差异。
只要遵循恶性肿瘤的手术原则，TLDG 就能达到与 LADG 相同的治疗效果。TLDG 对胃癌患者是安全可行的，但需要进一步研究。
