CAJ | 학술논문

目的探讨进展期胃癌腹腔镜辅助D2根治术的安全性和可行性.方法选择第四军医大学西京消化病医院2005年9月至2009年12月240例胃癌患者为研究对象,其中120例进展期胃癌接受腹腔镜辅助D2根治手术(腹腔镜组),120例进展期胃癌接受常规开腹D2根治手术(开腹组)为对照组,各组远端胃切除、全胃切除均分别为50例及70例.对患者的手术时间、术中出血量、淋巴结切除数量、肿瘤切缘情况、手术并发症、5年肿瘤复发情况、5年无病生存率进行对比分析.结果 120例腹腔镜组患者中均无中转开腹,平均手术时间(307±84) min,明显长于开腹组的(203±52) min(t'=11.556,P＜0.01);腹腔镜组术中出血量(258±78) ml,明显少于开腹组的(318±89) ml(=5.550,P＜0.01);腹腔镜组获取淋巴结数(17±11)枚,开腹组获取淋巴结数(16±10)枚,两组间差异无统计学意义(t =0.723,P＞0.05).腹腔镜组与开腹组所有切除标本切缘均阴性、无肿瘤细胞残留.腹腔镜组有9例患者发生手术相关并发症,发生率为7.5％,开腹组8例,发生率为6.7％,两组间差异无统计学意义(x2=0.252,P＞0.05).腹腔镜组术后住院(10.6±4.7)d,明显少于开腹组的(14.3±2.9) d(t'=7.339,P＜0.01).两组住院期间均无死亡发生.中位随访期47个月,腹腔镜组与开腹组的5年无病生存率分别是47.6％和42.8％(x2=0.577,P＞0.05). 结论腹腔镜辅助进展期胃癌根治手术是一种安全、可行的手术治疗方法.
목적 탐토진전기위암복강경보조D2근치술적안전성화가행성.방법 선택제사군의대학서경소화병의원2005년9월지2009년12월240례위암환자위연구대상,기중120례진전기위암접수복강경보조D2근치수술(복강경조),120례진전기위암접수상규개복D2근치수술(개복조)위대조조,각조원단위절제、전위절제균분별위50례급70례.대환자적수술시간、술중출혈량、림파결절제수량、종류절연정황、수술병발증、5년종류복발정황、5년무병생존솔진행대비분석.결과 120례복강경조환자중균무중전개복,평균수술시간(307±84) min,명현장우개복조적(203±52) min(t'=11.556,P＜0.01);복강경조술중출혈량(258±78) ml,명현소우개복조적(318±89) ml(=5.550,P＜0.01);복강경조획취림파결수(17±11)매,개복조획취림파결수(16±10)매,량조간차이무통계학의의(t =0.723,P＞0.05).복강경조여개복조소유절제표본절연균음성、무종류세포잔류.복강경조유9례환자발생수술상관병발증,발생솔위7.5％,개복조8례,발생솔위6.7％,량조간차이무통계학의의(x2=0.252,P＞0.05).복강경조술후주원(10.6±4.7)d,명현소우개복조적(14.3±2.9) d(t'=7.339,P＜0.01).량조주원기간균무사망발생.중위수방기47개월,복강경조여개복조적5년무병생존솔분별시47.6％화42.8％(x2=0.577,P＞0.05). 결론 복강경보조진전기위암근치수술시일충안전、가행적수술치료방법.
Objective This study was to compare surgical safety and oncologic adequacy of laparoscopy-assisted gastrectomy (LAG) versus open gastrectomy (OG) for advanced gastric cancer.Methods 120 consecutive AGC patients undergoing LAG with D2 lymph node dissection between September 2005 to December 2009 were compared with 120 AGC patients undergoing OG during the same period.In each group,50 underwent distal gastrectomy,70 for total gastrectomy.Results There was no conversion to open surgery in LAG.The operative time was significantly longer in LAG than OG [(307 ± 84) min vs.(203 ± 52) min,t'=11.556,P ＜ 0.01].The estimated blood loss was significantly less in LAG group than OG group [(258 ± 78) ml vs.(318 ± 89) ml,t =5.550,P ＜ 0.01].The number of lymph nodes retrieved was(17 ±11) in LAG,(16 ±10)in OG (t =0.723,P＞0.05).All margins were tumor free in both groups.9 patients had the postoperative complication in LAG,8 patients in OG (P ＞ 0.05).Length of postoperative stay was significantly shorter in LAG than OG [(10.6 + 4.7) vs.(14.3 ± 2.9) days,t' =7.339,P ＜0.01].There was no mortality in both groups.The 5-year recurrence-free survival rate were comparable (47.6％ in LAG vs.42.8％ in OG,x2 =0.577,P ＞ 0.05) between the two groups.Conclusions This study suggested that laparoscopy-assisted gastrectomy is safe and feasible in terms of surgical outcome and oncologic adequacy for advanced gastric cancer.