完全腹腔鏡遠端胃癌D2根治術在進展期胃癌中的臨床應用價值

沈乃營++何盟國+劉昌++++++王智翔

[摘要] 目的 對比分析完全腹腔鏡與開腹遠端胃癌D2根治術在進展期胃癌中的應用價值。 方法 回顧性分析2009年1月～2012年2月陜西核工業二一五醫院收治的接受完全腹腔鏡胃癌D2根治手術的進展期胃癌患者68例（腹腔鏡組）及接受開腹胃癌D2根治手術的進展期胃癌患者72例（開腹組）的臨床資料，對比分析兩組所用手術時間、術中出血量、術后肛門排氣時間、術后住院時間、術后并發癥、淋巴結清除數、腫瘤距遠近切緣距離、1年及3年生存率。 結果 腹腔鏡組手術時間明顯較開腹組長，但術中出血量明顯較開腹組少，差異均有高度統計學意義（P < 0.01）；腹腔鏡組的術后肛門排氣時間、術后住院時間均少于開腹組，差異均有高度統計學意義（P < 0.01）；兩組淋巴結清掃數目比較，差異無統計學意義（P > 0.05）；兩組距遠、近切端距腫瘤距離比較，差異無統計學意義（P > 0.05）。兩組術后并發癥發生率比較，差異無統計學意義（P > 0.05）。腹腔鏡組的1、3年生存率分別為100.0%、89.7%，開腹組分別為100.0%、90.3%，差異均無統計學意義（P > 0.05）。 結論 完全腹腔鏡遠端胃癌D2根治術治療進展期胃癌是安全、可行的，可以達到與開腹手術同樣的根治效果。

[關鍵詞] 腹腔鏡手術；D2根治術；進展期胃癌

[中圖分類號] R735.2 [文獻標識碼] A [文章編號] 1673-7210（2015）10（b）-0013-04

Clinical application value of totally laparoscopic D2 gastrectomy for advanced gastric cancer

SHEN Naiying1.2 HE Mengguo1 LIU Chang2 WANG Zhixiang1

1.Department of Hepatobiliary Surgery， Shaanxi Nuclear Geology 215 Hospital， Shaanxi Province， Xianyang 712000， China； 2.Department of Hepatobiliary Surgery， the First Affiliated Hospital of Xi'an Jiaotong University， Shaanxi Province， Xi'an 711061， China

[Abstract] Objective To investigate the clinical value of totally laparoscopy D2 surgery for advanced gastric cancer by thecomparative analysis of totally laparoscopy and open the distal gastric D2 radical surgery. Methods From January 2009 to February 2012， the clinical data of 68 patients with advanced gastric cancer received totally laparoscopy （laparoscopy group） and 72 patients with advanced gastric cancer received open surgery （open surgery group） in Shaanxi Nuclear Geology 215 Hospital were analyzed. Clinical parameters including operation time， blood loss， postoperative exhausting time， postoperative hospital stay， complications， and the number of lymph nodes dissected， length of proximal and distal margin to the cancer， 1-year and 3-year survival rates of two groups were observed. Results The operation time in laparoscopic group was longer than that in open surgery group， but the volume of bleeding was less than that in laparoscopic group， the differences were statistically significant（P < 0.01）； and the postoperative exhausting time and hospital stay after operation were shorter than that in open surgery group， the difference were statistically significant （P < 0.01）. Compared the number of lymphadenectomy in the two groups ， the difference was not statistically significant （P > 0.05）. There were no significant differences between two groups in rate of complications， number of lymph nodes and length of proximal and distal margin to the cancer （P > 0.05）. The 1-year and 3-year survival rates were 100.0%， 89.7% in laparoscopy group and 100.0%， 90.3% in open surgery group respectively， and there were no significant differences between two groups （P > 0.05）. Conclusion Totally laparoscopic D2 gastrectomy is safe and feasible for advanced gastric cancer， and has similar radical effect compared with open surgery.