CAJ | 학술논문

目的：对比分析完全腹腔镜与开腹远端胃癌D2根治术在进展期胃癌中的应用价值。方法回顾性分析2009年1月~2012年2月陕西核工业二一五医院收治的接受完全腹腔镜胃癌D2根治手术的进展期胃癌患者68例(腹腔镜组)及接受开腹胃癌D2根治手术的进展期胃癌患者72例(开腹组)的临床资料，对比分析两组所用手术时间、术中出血量、术后肛门排气时间、术后住院时间、术后并发症、淋巴结清除数、肿瘤距远近切缘距离、1年及3年生存率。结果腹腔镜组手术时间明显较开腹组长，但术中出血量明显较开腹组少，差异均有高度统计学意义(P<0.01)；腹腔镜组的术后肛门排气时间、术后住院时间均少于开腹组，差异均有高度统计学意义(P<0.01)；两组淋巴结清扫数目比较，差异无统计学意义(P>0.05)；两组距远、近切端距肿瘤距离比较，差异无统计学意义(P>0.05)。两组术后并发症发生率比较，差异无统计学意义(P>0.05)。腹腔镜组的1、3年生存率分别为100.0%、89.7%，开腹组分别为100.0%、90.3%，差异均无统计学意义(P>0.05)。结论完全腹腔镜远端胃癌D2根治术治疗进展期胃癌是安全、可行的，可以达到与开腹手术同样的根治效果。
목적：대비분석완전복강경여개복원단위암D2근치술재진전기위암중적응용개치。방법회고성분석2009년1월~2012년2월협서핵공업이일오의원수치적접수완전복강경위암D2근치수술적진전기위암환자68례(복강경조)급접수개복위암D2근치수술적진전기위암환자72례(개복조)적림상자료，대비분석량조소용수술시간、술중출혈량、술후항문배기시간、술후주원시간、술후병발증、림파결청제수、종류거원근절연거리、1년급3년생존솔。결과복강경조수술시간명현교개복조장，단술중출혈량명현교개복조소，차이균유고도통계학의의(P<0.01)；복강경조적술후항문배기시간、술후주원시간균소우개복조，차이균유고도통계학의의(P<0.01)；량조림파결청소수목비교，차이무통계학의의(P>0.05)；량조거원、근절단거종류거리비교，차이무통계학의의(P>0.05)。량조술후병발증발생솔비교，차이무통계학의의(P>0.05)。복강경조적1、3년생존솔분별위100.0%、89.7%，개복조분별위100.0%、90.3%，차이균무통계학의의(P>0.05)。결론완전복강경원단위암D2근치술치료진전기위암시안전、가행적，가이체도여개복수술동양적근치효과。
Objective To investigate the clinical value of totally laparoscopy D2 surgery for advanced gastric cancer by thecomparative analysis of totally laparoscopy and open the distal gastric D2 radical surgery. Methods From January 2009 to February 2012, the clinical data of 68 patients with advanced gastric cancer received totally laparoscopy (la-paroscopy group) and 72 patients with advanced gastric cancer received open surgery (open surgery group) in Shaanxi Nuclear Geology 215 Hospital were analyzed. Clinical parameters including operation time, blood loss, postoperative ex-hausting time, postoperative hospital stay, complications, and the number of lymph nodes dissected, length of proximal and distal margin to the cancer, 1-year and 3-year survival rates of two groups were observed. Results The operation time in laparoscopic group was longer than that in open surgery group, but the volume of bleeding was less than that in laparoscopic group, the differences were statistically significant (P< 0.01); and the postoperative exhausting time and hospital stay after operation were shorter than that in open surgery group, the difference were statistically significant (P<0.01). Compared the number of lymphadenectomy in the two groups , the difference was not statistically significant (P>0.05). There were no significant differences between two groups in rate of complications, number of lymph nodes and length of proximal and distal margin to the cancer (P > 0.05). The 1-year and 3-year survival rates were 100.0%, 89.7% in laparoscopy group and 100.0%, 90.3% in open surgery group respectively, and there were no significant dif-ferences between two groups (P> 0.05). Conclusion Totally laparoscopic D2 gastrectomy is safe and feasible for ad-vanced gastric cancer, and has similar radical effect compared with open surgery.