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目的对比分析腹腔镜辅助远端胃癌D2根治术与传统开腹术的手术时间、手术创伤程度,探讨腹腔镜辅助远端胃癌D2根治术的应用价值。方法选取2009年3月至2013年9月间收治的172例癌患者,其中行传统开腹手术80例,行腹腔镜手术92例。回顾性对比分析两种手术方式的手术时间、术中出血量、手术切口长度、淋巴结清扫枚数、术后患者疼痛情况、围手术期并发症情况及术后恢复情况等指标。结果两组患者在不同手术方式下均顺利完成手术。腹腔镜手术组患者手术时间、术中出血量及切口长度明显优于传统开腹手术(P<0.05),但术中淋巴结清扫枚数两组无明显差异(P>0.05)。术后采用视觉模拟评分(VAS)评估两组患者术后疼痛情况,腹腔镜手术组明显优于开腹手术组(P<0.05)。腹腔镜手术组首次肛门排气时间、首次排便时间、首次下床活动时间、术后住院时间明显少于开腹手术组(P<0.05)。两种手术方式,术后吻合口瘘、吻合口出血、十二指肠残端瘘、切口愈合等围手术期并发症无明显差异,但肺部感染腹腔镜手术组明显好于开腹手术组(P<0.05)。结论腹腔镜辅助远端胃癌D2根治术与传统开腹远端胃癌D2根治术比较,具有对患者创伤小,术后疼痛耐受好,恢复快,围手术期并发症少等优点,值得临床推广应用。
Objective To compare and analyze the laparoscopic-assisted D2 distal root canal surgery and traditional laparotomy operation time, degree of surgical trauma, and explore the value of laparoscopic-assisted D2 distal root canal surgery. Methods A total of 172 cancer patients were selected from March 2009 to September 2013. Among them, 80 cases were performed conventional laparotomy and 92 cases were performed laparoscopic surgery. Retrospective analysis of two surgical methods of operation time, blood loss, surgical incision length, the number of lymph node dissection, postoperative patient pain, perioperative complications and postoperative recovery and other indicators. Results Both groups underwent successful operation under different surgical methods. The operation time, intraoperative blood loss and incision length of laparoscopic surgery group were significantly better than those of conventional laparotomy (P <0.05). However, there was no significant difference between the two groups (P> 0.05). Postoperative visual analogue scale (VAS) was used to evaluate postoperative pain in both groups. Laparoscopic surgery group was significantly better than open surgery group (P <0.05). The time of the first anal exhaust, the first defecation, the time of initial ambulation, and the postoperative hospital stay in laparoscopic surgery group were significantly less than those in open surgery group (P <0.05). There was no significant difference in the perioperative complications between the two operation methods, anastomotic fistula, anastomotic bleeding, duodenal stump fistula, incision healing, etc. However, the laparoscopic surgery group with pulmonary infection was significantly better than the open surgery group (P <0.05). Conclusions Laparoscopic-assisted D2 distal radical gastrectomy is more effective than traditional D2 radical gastrectomy in the treatment of distal gastric cancer, which has the advantages of less invasiveness, better postoperative pain tolerance, faster recovery and fewer perioperative complications, which is worthy of clinical promotion application.