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目的探讨开腹和腹腔镜原发灶切除联合D2淋巴结清扫术治疗老年进展期胃癌的临床疗效及安全性。方法选取老年进展期胃癌患者140例,采用随机抽签法分为开腹组(70例)和腹腔镜组(70例),分别施行开腹和腹腔镜原发灶切除联合D2淋巴结清扫术治疗;比较2组患者的手术时间、术中出血量、术中Pa CO2水平,术后进流质饮食时间、术后肛门排气时间、术后胃管留置时间、术后离床活动时间、术后血红蛋白(Hb)水平,住院时间、淋巴结清扫数目,术后3年的累积总生存率和无病生存率以及术后并发症发生率。结果 2组患者手术时间比较差异无统计学意义(P>0.05);腹腔镜组患者术中出血量、术后进流质饮食时间、术后肛门排气时间、术后胃管留置时间、术后离床活动时间、术后Hb水平及住院时间均明显优于开腹组,差异具有统计学意义(P<0.05);腹腔镜组患者术中Pa CO2水平明显高于开腹组,差异具有统计学意义(P<0.05);2组患者胃周淋巴结和胃动脉周围淋巴结清扫数目比较差异无统计学意义(P>0.05);2组患者术后随访3年的累积总生存率和无病生存率比较差异均无统计学意义(P>0.05);同时腹腔镜组患者术后并发症发生率明显低于开腹组,差异具有统计学意义(P<0.05)。腹腔镜组患者在术后7 d及术后3个月的生活质量评分显著高于开腹组,差异有统计学意义(P<0.05)。结论腹腔镜下原发灶切除联合D2淋巴结清扫术治疗老年进展期胃癌具有微创、术后恢复时间短及术后并发症少等优势。
Objective To investigate the clinical efficacy and safety of laparotomy and laparoscopic primary resection combined with D2 lymph node dissection in the treatment of advanced gastric cancer. Methods A total of 140 elderly patients with advanced gastric cancer were enrolled in this study. They were randomly divided into two groups: laparotomy group (70 cases) and laparoscopic group (70 cases). The patients underwent laparoscopic primary laparoscopic resection combined with D2 lymph node dissection. The operation time, intraoperative blood loss, intraoperative PaCO 2 level, postoperative fluid intake time, postoperative anal exhaust time, postoperative gastric tube indwelling time, postoperative ambulation time, postoperative hemoglobin (Hb), length of hospital stay, number of lymph node dissection, cumulative total survival and disease-free survival after 3 years and the incidence of postoperative complications. Results There was no significant difference in operative time between the two groups (P> 0.05). The amount of bleeding during operation, the time of liquid intake in the laparoscopic group, the postoperative anal exhaust time, the postoperative gastric tube indwelling time, The time of leaving the bed, postoperative Hb level and hospital stay were significantly better than those in the open group (P <0.05). The level of PaCO 2 in the laparoscopic group was significantly higher than that in the open group (P <0.05). There was no significant difference in the number of lymphadenectasis between the two groups (P> 0.05). The two groups were followed up for 3 years, the cumulative total survival rate and disease-free survival There was no significant difference between the two groups (P> 0.05). The incidence of postoperative complications in laparoscopic group was significantly lower than that in open group, the difference was statistically significant (P <0.05). The quality of life of patients in laparoscopic group at 7 days and 3 months after operation was significantly higher than that in open group, the difference was statistically significant (P <0.05). Conclusions Laparoscopic resection combined with D2 lymphadenectomy has the advantages of minimally invasive treatment, short postoperative recovery time and few postoperative complications.