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目的:对比分析腹腔镜辅助与开腹D2根治术在进展期胃癌中的治疗效果。方法:对2012年1月—2013年10月共55例进展期胃癌进行前瞻性研究,采用数字表法,随机分为腹腔镜辅助胃癌根治术(腹腔镜组)29例(其中2例中转开腹者被剔除)和开腹胃癌根治术(开腹组)26例,比较两组临床情况、淋巴结清扫数目及术后1年生存率。结果:腹腔镜组手术时间明显长于开腹组[(346±45)min vs.(286±32)min,P=0.038];腹腔镜组在术后肛门排气时间、下床活动时间以及术后住院天数方面均优于开腹组(均P<0.05);术中出血量、首次进流食时间两组比较差异无统计学意义(均P>0.05)。腹腔镜组平均每例清扫淋巴结数目与开腹组相比,差异无统计学意义[(20.6±8.4)枚vs.(21.2±11.0)枚,P=0.825]。随访时间6~35个月,腹腔镜组术后1年生存率(88.0%)与开腹组(84.0%)相比,两组比较差异无统计学意义(χ2=0.62,P=0.315)。结论:进展期胃癌腹腔镜辅助D2根治术能够达到与开腹手术相当的淋巴结清扫效果,在临床疗效方面具有微创优势。
OBJECTIVE: To compare and analyze the therapeutic effect of laparoscopic-assisted and open D2 radical mastectomy in advanced gastric cancer. Methods: From January 2012 to October 2013 a total of 55 cases of advanced gastric cancer were prospectively studied. The patients were randomly divided into laparoscopic radical gastrectomy group (laparoscopic group) Abdominal patients were excluded) and open radical gastrectomy (laparotomy) 26 cases, the clinical situation of the two groups, the number of lymph node dissection and 1-year survival rate. Results: The operation time of laparoscopic group was significantly longer than that of open group [(346 ± 45) min vs. (286 ± 32) min, P = 0.038]. The time of laparoscopic anus exhaust, ambulation time, (P <0.05). There was no significant difference between the two groups in the amount of blood loss and the first inflow of feeding time (P> 0.05). There was no significant difference in the number of lymph nodes per laparoscopic group compared with the open group [(20.6 ± 8.4) vs. (21.2 ± 11.0), P = 0.825]. The follow-up time ranged from 6 months to 35 months. There was no significant difference in the 1-year survival rate between the two groups (χ2 = 0.62, P = 0.315) compared with the open group (84.0%) after laparoscopic surgery. Conclusion: Laparoscopic-assisted D2 radical gastrectomy in advanced gastric cancer can achieve lymph node dissection equivalent to laparotomy and has minimally invasive advantages in clinical efficacy.