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目的探讨进展期胃癌完全腹腔镜D2根治手术的安全性和可行性。方法回顾分析6年间暨南大学附属第一医院普通外科进展期胃癌的完全腹腔镜D2根治手术26例患者(腔镜组)的临床资料,并以开腹手术45例(开腹组)作为对照。结果入选的71例手术均顺利完成。淋巴结清除数在两组间的差别无统计学意义(P>0.05)。腔镜组的手术时间比开腹组长,术中出血量比开腹组少,术后肛门排气时间和术后住院时间均比开腹组短(均P<0.05)。开腹组手术后发生并发症2例,其中吻合口出血1例,吻合口梗阻1例,均经非手术治疗好转;腔镜组手术无并发症发生。腔镜组术后随访4～63个月,失访1例;1,3,5年生存率分别为100%(20/20),92.3%(12/13),66.7%(2/3)。开腹组术后随访3～65个月,失访2例;1,3,5年生存率分别为100%(37/37),90.5%(19/21),71.4%(5/7)。两组间的1,3,5年生存率差别无统计学意义(P>0.05)。结论进展期胃癌的完全腹腔镜D2根治手术是安全、可行的,并体现了腹腔镜手术微创的优越性。
Objective To investigate the safety and feasibility of complete laparoscopic D2 radical surgery for advanced gastric cancer. Methods The clinical data of 26 patients undergoing total laparoscopic radical mastectomy (laparoscopic group) undergoing general surgery and advanced gastric cancer in the First Affiliated Hospital of Jinan University during the past 6 years were retrospectively analyzed. Forty-five patients (laparotomy) underwent laparotomy as a control. Results The selected 71 cases were successfully completed. There was no significant difference in the number of lymph node clearance between the two groups (P> 0.05). The operation time of laparoscopic group was shorter than that of laparotomy group. The amount of bleeding during operation was less than that of laparotomy group. The time of postoperative anal exhaust and postoperative hospital stay were shorter than that of laparotomy group (all P <0.05). There were 2 cases of complications after operation in open group, including 1 case of anastomotic bleeding and 1 case of anastomotic obstruction, which were all improved by non-surgical treatment; no complications occurred in endoscopic surgery. The laparoscopic group was followed up for 4 to 63 months and 1 patient was lost to follow-up. The 1-, 3-, and 5-year survival rates were 100% (20/20), 92.3% (12/13), 66.7% (2/3) . The laparotomy group was followed up for 3 to 65 months and 2 cases were lost to follow-up. The 1-, 3-, 5-year survival rates were 100% (37/37), 90.5% (19/21), 71.4% (5/7) . There was no significant difference in the 1,3,5-year survival rates between the two groups (P> 0.05). Conclusion The complete laparoscopic D2 radical gastrectomy for advanced gastric cancer is safe and feasible, and reflects the advantages of minimally invasive laparoscopic surgery.