CAJ | 학술논문

目的评估腹腔镜辅助胃癌根治术的近期及远期疗效.方法选取浙江大学附属邵逸夫医院普外科2004年10月至2008年3月间行胃癌根治术的病例,根据患者的性别、年龄、胃切除范围、肿瘤分化及TNM分期为指标,按照1∶1病例配对的方式分为腹腔镜辅助胃癌根治术组(LAG组)和开腹胃癌根治术组(OG组)各85例,比较2组患者的手术时间、术中失血量、术后恢复情况、并发症、术后病理及远期随访结果.结果相比于OG组,LAG组手术时间长[(277±62) min比(211±46) min,t=7.882,P＜0.05)],但术中出血少[(161±90) ml比(267±141)ml,t=-5.854,P＜ 0.05]；LAG组患者术后肛门排气时间[(3.7±1.3)d比(4.2±1.1 d),t=-2.318]、住院时间[(10±3)d比(12±6)d]均短于OG组(t=-2.325,P ＜0.05).2组之间淋巴结清扫数目、术后总体并发症发生率相比差异无统计学意义(P＞0.05).LAG组和OG组5年无瘤生存率、总生存率分别为76％、78％和75％、73％,差异无统计学意义(P＞0.05)；将2组病例按肿瘤TNM分期分层后分别作对比,则相同分期下2组之间生存率相比差异仍无统计学意义(P＞0.05).结论腹腔镜辅助胃癌根治术微创效果明显,术后恢复快,与开腹手术相比并不会增加患者术后远期复发和死亡的风险.
목적 평고복강경보조위암근치술적근기급원기료효.방법 선취절강대학부속소일부의원보외과2004년10월지2008년3월간행위암근치술적병례,근거환자적성별、년령、위절제범위、종류분화급TNM분기위지표,안조1∶1병례배대적방식분위복강경보조위암근치술조(LAG조)화개복위암근치술조(OG조)각85례,비교2조환자적수술시간、술중실혈량、술후회복정황、병발증、술후병리급원기수방결과.결과 상비우OG조,LAG조수술시간장[(277±62) min비(211±46) min,t=7.882,P＜0.05)],단술중출혈소[(161±90) ml비(267±141)ml,t=-5.854,P＜ 0.05]；LAG조환자술후항문배기시간[(3.7±1.3)d비(4.2±1.1 d),t=-2.318]、주원시간[(10±3)d비(12±6)d]균단우OG조(t=-2.325,P ＜0.05).2조지간림파결청소수목、술후총체병발증발생솔상비차이무통계학의의(P＞0.05).LAG조화OG조5년무류생존솔、총생존솔분별위76％、78％화75％、73％,차이무통계학의의(P＞0.05)；장2조병례안종류TNM분기분층후분별작대비,칙상동분기하2조지간생존솔상비차이잉무통계학의의(P＞0.05).결론 복강경보조위암근치술미창효과명현,술후회복쾌,여개복수술상비병불회증가환자술후원기복발화사망적풍험.
Objective To evaluate the short-and long-term outcomes of laparoscopy-assisted gastrectomy (LAG) for gastric cancer.Methods After studying the patients' demographic data,extent of gastrectomy and lymphadenectomy,as well as differentiation and tumor TNM stage,85 patients who underwent LAG were individually matched to 85 patients who underwent open surgery (OG) between October 2004 and March 2008.The operative time,intraoperative blood loss,postoperative recovery,complications,pathological findings,and follow-up data were compared between the two groups.Results The mean operative time was significantly longer in the LAG group than in the OG group (277 ± 62) min vs.(211 ±46) min,t =7.882,P ＜0.05,whereas intraoperative blood loss was significantly lower (161 ±90) ml vs.(267 ± 141) ml,t =-5.854,P ＜0.05.In addition,there was a significant reduction in the time to first flatus and postoperative hospital stay (3.7 ± 1.3) days vs.(4.2 ± 1.1) days and (10 ± 3) days vs.(12 ± 6) days,respectively t =-2.318,-2.325,P ＜ 0.05.There was no significant difference between the LAG group and OG group with regard to the number of harvested lymph nodes and overall postoperative complications.The 5-year disease-free survival rates and overall survival rates were 76％,78％,respectively,in LAG group and 75％,73％,respectively in OG group (all P ＞ 0.05).Conclusions LAG is suitable and minimally invasive for treating gastric cancer.Compared to OG,the LAG will not increase the risk of recurrence and mortality after surgery.