CAJ | 학술논문

目的：比较腹腔镜辅助远端胃癌根治术与开腹远端胃癌根治术治疗进展期胃癌的疗效比较。方法收集76例由同一组医师连续实施远端胃癌根治术的进展期胃癌患者的临床资料。其中行腹腔镜辅助远端胃癌根治术46例（腹腔镜组），行开腹远端胃癌根治术30例（开腹组）。对2组患者的手术时间、术中出血量、术后通气时间、术后住院时间、住院费用、清扫淋巴结数目、术后并发症（伤口感染、粘连性肠梗阻、胃瘫、吻合口漏等）的发生情况及近期疗效（1、3年的生存率和无瘤生存率）进行比较。结果腹腔镜组的手术时间、住院费用、清扫淋巴结数目、术中出血量及术后并发症例数与开腹组比较差异均无统计学意义（均 P ＞0．05）。腹腔镜组术后通气时间及术后住院时间均明显短于开腹组（均 P ＜0．05）。2组患者术中均未发生损伤大血管或周围脏器等严重并发症，腹腔镜组无转开腹病例。2组患者均随访10～52（26．8±9．8）个月，1、3年生存率和无瘤生存率比较差异均无统计学意义（均 P ＞0．05）。结论对于进展期胃癌患者，腹腔镜辅助远端胃癌根治术是一种可行而短期疗效好的手术方式，远期疗效仍需长期随访。
목적：비교복강경보조원단위암근치술여개복원단위암근치술치료진전기위암적료효비교。방법수집76례유동일조의사련속실시원단위암근치술적진전기위암환자적림상자료。기중행복강경보조원단위암근치술46례（복강경조），행개복원단위암근치술30례（개복조）。대2조환자적수술시간、술중출혈량、술후통기시간、술후주원시간、주원비용、청소림파결수목、술후병발증（상구감염、점련성장경조、위탄、문합구루등）적발생정황급근기료효（1、3년적생존솔화무류생존솔）진행비교。결과복강경조적수술시간、주원비용、청소림파결수목、술중출혈량급술후병발증례수여개복조비교차이균무통계학의의（균 P ＞0．05）。복강경조술후통기시간급술후주원시간균명현단우개복조（균 P ＜0．05）。2조환자술중균미발생손상대혈관혹주위장기등엄중병발증，복강경조무전개복병례。2조환자균수방10～52（26．8±9．8）개월，1、3년생존솔화무류생존솔비교차이균무통계학의의（균 P ＞0．05）。결론대우진전기위암환자，복강경보조원단위암근치술시일충가행이단기료효호적수술방식，원기료효잉수장기수방。
Objective Comparison of laparoscopic-assisted and open radical distal gastrectomy for advanced gastric cancer.Methods Clinical data of 76 patients with advanced gastric cancer who were treated with radical distal gastrectomy by the same group of doctors were collected.A-mong the 76 patients,46 underwent laparoscopic-assisted radical distal gastrectomy(laparoscopic group)and 30 underwent open radical distal gastretctomy(open group).The operation time,intra-operative blood loss,time to first postoperative flatus,hospital stay,hospitalization costs,number of lymph nodes harvested,postoperative complications(wound infection,adhesive intestinal ob-struction,gastroplegia,anastomotic leakage,etc.)and short-term effects(1-year and 3-year sur-vival rates and disease-free survival rate)were compared between the two groups.Results There were no significant differences in operation time,intraoperative blood loss,hospitalization costs, number of lymph nodes harvested and incidence of postoperative complications between the two groups(P >0.05).Compared with open group,the time to first postoperative flatus and length of hospital stay were obviously shortened in laparoscopic group(P <0.05).No large blood vessel or surrounding organ damage and other serious complications were observed in both groups.No pa-tients were converted to open surgery in laparoscopic group.All patients were followed up for an average of(26.8±9.8)months(range 10 to 52 months),and no significant differences in the 1-year and 3-year survival rates and disease-free survival rate were found between the two groups( P >0.05).Conclusion Laparoscopic-assisted radical distal gastrectomy is feasible and produces good short-term efficacy in patients with advanced gastric cancer.However,the long-term efficacy needs to be further confirmed.