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目的:比较全腔镜与开腹远端胃癌D_2根治术的疗效及对免疫功能影响。方法:回顾性分析2009—2013年收治的远端胃癌患者的临床相关资料,按纳入及排除标准筛选出78例远端胃癌患者。38例采取全腹腔镜下D_2根治术(TLDG组),40例采取开腹D_2根治术(ODG组),比较两组患者的疗效与免疫功能指标。结果:与ODG组比较,TLDG组手术时间(229.3 min vs.197.7 min)与消化道重建时间(27.6 min vs.18.5 min)明显延长,但术中出血量(99.5 m L vs.175.3 m L)、术后首次排气时间(3.6 d vs.4.7 d)、术后理论出院时间(10.7 d vs.14.7 d)均明显减少(均P<0.05);而淋巴结清扫数目、近切缘距离、术后并发症发生率、随访率、复发转移率、2年生存率两组间差异无统计学意义(均P>0.05);术后1、7 d所测白细胞、IL-6、CRP水平均明显降低(均P<0.05)。结论:全腹腔镜下远端胃癌根治术具有微创、对免疫功能影响小、术后恢复快的优势,是一种安全、可行、有效的手术方式。
Objective: To compare the curative effect of D 2 radical mastectomy with endoscopic gastric cancer and its immune function. Methods: The clinical data of patients with distal gastric cancer admitted from 2009 to 2013 were retrospectively analyzed. According to inclusion and exclusion criteria, 78 patients with distal gastric cancer were screened out. Thirty-eight patients underwent total laparoscopic radical d 2 (TLDG) and 40 patients underwent open radical d 2 (ODG). The efficacy and immune function of the two groups were compared. Results: Compared with ODG group, the operation time (229.3 min vs 197.7 min) and the digestive tract reconstruction time (27.6 min vs.18.5 min) in TLDG group were significantly longer, but the intraoperative blood loss (99.5 m L vs. 1.753 m L) (3.6 d vs 4.7 d), and the postoperative discharge time (10.7 d vs 14.7 d) were significantly decreased (all P <0.05). However, the number of lymph node dissection, the distance of proximal margin, The incidence of postoperative complication, follow-up rate, recurrence and metastasis rate, 2-year survival rate had no significant difference between the two groups (all P> 0.05). The levels of leukocyte, IL-6 and CRP Decreased (all P <0.05). Conclusion: Total laparoscopic radical gastrectomy for distal gastric cancer has the advantages of minimal invasion, little effect on immune function and rapid recovery after operation. It is a safe, feasible and effective surgical method.