摘要目的 探讨进展期胃癌行腹腔镜手术的安全性和可行性,并评价其远期疗效.方法 选择2008年6月至2009年12月46例进展期胃癌患者行腹腔镜辅助胃癌根治术,与同期85例行传统开腹胃癌手术的患者进行对比分析,比较2组患者的手术情况、术后恢复情况、并发症、根治程度及远期疗效.结果 腹腔镜组手术时间为(274±78) min,长于开腹组[(217 ±41) min],2组间差异有统计学意义(t =4.635,P=0.000)；腹腔镜组术中出血量[(254±112)ml]、首次下床活动时间[(63±16)h]、术后镇痛时间[(53±20)h]、首次肛门排气时间[(77 ±20) h]、进流食时间[(88±15)h]及术后住院时间[(11.1±4.6)d]明显优于开腹组(t=3.942、5.549、9.464、6.508、9.436、2.980,P＜0.01)；腹腔镜组肿瘤近、远端切缘长度分别为(5.7±1.4)、(4.9±2.1)cm,开腹组分别为(5.8±1.1)、(4.7±1.5)cm,2组差异无统计学意义.腹腔镜组淋巴结清扫数量为(30.5±10.4)枚,开腹组为(32.6±12.3)枚,2组比较差异无统计学意义(P =0.339).腹腔镜组术后并发症发生率(8.7％)及死亡率(0)均低于开腹组,但差异无统计学意义.患者随访时间6 ～48个月,2组患者总体生存率差异无统计学意义(x2=1.594,P=0.207).结论 进展期胃癌患者行腹腔镜辅助胃癌根治术具有创伤小、术后恢复快、住院时间短等优点,其手术安全性、根治程度及远期生存率与开腹手术相当.

abstractsObjective To evaluate the safety,feasibility and the long-term outcomes of laparoscopy-assisted gastrectomy (LAG) for advanced gastric cancer (AGC).Methods The clinical and follow-up data of 46 cases after LAG from June 2008 to December 2009 were analyzed,and compared with 85 cases after conventional open gastrectomy (OG) for advanced gastric cancer at the same period at our hospital.The surgical safety,postoperative recovery,complications,radical degree,survival rate were compared.Results As compared with OG group,operation time was longer in LATG group ((274 ±78) min vs.(217 ±41) min,t =4.635,P =0.000).Estimated blood loss in the LAG group ((254 ±112) ml) was significantly less than in the OG group (t =3.942,P =0.000).Time to ambulation ((63 ±16) hours),first flatus ((77 ±20) hours),resumed liquid diet ((88 ± 15) hours),duration of analgesic medication ((53 ± 20) hours) and postoperative hospital stay ((11.1 ± 4.6) days) were significantly shorter in the LAG group (t =5.549,6.508,9.436,9.464 and 2.980 respectively,all P ＜ 0.01).The distance of the proximal and distal resection margin were (5.7 ± 1.4) cm and (3.9 ± 1.5) cm in LAG group,(5.8 ± 1.1) cm and (4.7 ± 1.5) cm in OG group respectively,but the difference was not significant.The number of lymph node dissections was also similar,(30.5 ± 10.4) in LAG group and (32.6 ± 12.3) in OG group (t =0.960,P =0.339).The incidence of postoperative complications and mortality rate in LAG group (8.7％ and 0 respectively) were also lower than in the OG group,with no statistically significant difference (P ＞ 0.05).The mean follow-up was 31.0 months (range 6-48 months),and the cumulative survival of the 2 groups was similar (x2 =1.594,P =0.207).Conclusions Laparoscopy-assisted gastrectomy for advanced gastric cancer is not significantly different with open surgery in surgical safety,radical degree,and survival rate.It is less traumatic and of fewer complications.