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目的探讨腹腔镜辅助下远端胃癌D2根治术治疗进展期胃癌的疗效及安全性。方法选择宜昌市中心人民医院2010年8月至2013年8月间收治的68例进展期胃癌患者,按照临床前瞻性研究原则将患者分为腹腔镜治疗组(观察组)和远端胃癌D2根治术治疗组(对照组),观察两组患者手术相关指标、术后恢复情况以及治疗效果。结果与对照组比较,观察组患者的手术时间、切口长度、术中出血量、术后肛门排气时间、下床活动时间、进流质饮食时间、住院时间以及并发症中的切口感染、吻合口瘘的发生率均明显降低,差异均有统计学意义(均P<0.05)。但清扫淋巴结总数、远切端距肿瘤距离均降低,近切端距肿瘤距离则增加,但差异无统计学意义(P>0.05)。两组患者的存活率比较,差异无统计学意义(P>0.05)。结论腹腔镜辅助下远端胃癌D2根治术治疗进展期胃癌安全、有效,可达到与开腹手术相当的根治效果,近期疗效甚佳,并发症较少。
Objective To investigate the efficacy and safety of laparoscopic D2-assisted radical distal gastric cancer in the treatment of advanced gastric cancer. Methods Sixty-eight patients with advanced gastric cancer admitted to Yichang Central People’s Hospital from August 2010 to August 2013 were divided into laparoscopic group (observation group) and D2 radical group according to the principle of clinical prospective study (Control group). The operation related indexes, postoperative recovery and treatment effect were observed in the two groups. Results Compared with the control group, the operation time, incision length, intraoperative blood loss, postoperative anal exhaust time, ambulation time, fluid intake time, hospital stay and complications in the observation group were significantly different The incidence of fistula was significantly lower, the differences were statistically significant (P <0.05). However, the total number of dissected lymph nodes, far away from the tumor away from the tumor were reduced near the end of the distance from the tumor increased, but the difference was not statistically significant (P> 0.05). There was no significant difference in survival rate between the two groups (P> 0.05). Conclusions Laparoscopic assisted D2 radical mastectomy for distal gastric cancer is safe and effective in treating advanced gastric cancer, which can achieve the same curative effect as laparotomy. The short-term curative effect is very good with fewer complications.