腹腔镜与开腹手术对进展期胃癌D2根治术的临床对比分析

【】　目的　研究腹腔镜行进展期胃癌根治术较传统开腹手术在围手术期临床和生化指标的变化，进一步探讨其临床应用的优越性。　方法　采用统一入组标准、同期临床对比研究方法，对2010年1-12月腹腔镜手术组和开腹手术组完成的112例进展期胃癌根治术患者在围手术期临床指标和生化指标的比较分析，其中腹腔镜手术组59例，开腹手术组53例。　结果　腹腔镜组手术切口长度为（5.77±0.74）cm，开腹手术组为（12.05±1.30）cm，组间差异有统计学意义（t=-30.921，P=0.000）；腹腔镜组术中失血量为（107.20±27.23）mL，开腹手术组为（168.87±96.76）mL，组间差异有统计学意义（t=-4.483，P=0.000）；腹腔镜组术后住院时间为（7.19±0.97）d，开腹手术组为（8.32±1.16）d，组间差异有统计学意义（t=-5.634，P=0.000）；腹腔镜组手术时间为（202.12±15.71）min，开腹手术组为（196.32±16.73）min，组间差异无统计学意义（t=1.891，P=0.061）；腹腔镜组清扫淋巴结枚数（14.15±4.51）枚，开腹手术组（15.25±5.17）枚，组间差异无统计学意义（t=0.736，P=0.471）；腹腔镜组肠功能恢复时间为（57.88±9.70）h，开腹手术组为（59.16±10.82）h，组间差异无统计学意义（t=-0.655，P=0.514）。两组前白蛋白和血红蛋白水平差异无统计学意义（P>0.05）。　结论　进展期胃癌行腹腔镜手术与传统开腹手术比较，并不加重患者创伤反应，也不增加手术并发症，具有手术切口小、术中出血少、术后恢复快等优点。【Abstract】　Objective　Toevaluatethedifferencesbetweenlaparoscopyandopensurgeryfortreatingadvancedgastriccancerinperi-operativeclinicalandbiochemicalindexes,inordertoinvestigatethesuperiorityoflaparoscopyintreatingthedisease.　Methods　Thesameincludingstandardsanddouble-blindrandomizedcontrolstudywerecarriedouttocomparetheperi-operativeclinicalandbiochemicalindexesof112patientswhounderwentradicaltreatmentforadvancedgastriccancerfromJanuarytoDecember2010.Amongthem,59patientswereincludedinthelaparoscopicgroup,and53inthetraditionalopenoperationgroup.　Results　Comparedwiththeopensurgerygroup,theincisionlength(5.77±0.74)cmvs.(12.05±1.30)cm;t=-30.921,P=0.000,intraoperationalbloodloss(107.20±27.23)mLvs.(168.87±96.76)mL;t=-4.483,P=0.000andhospitalstaytime(7.19±0.97)daysvs.(8.32±1.16)days;t=-5.634,P=0.000weresignificantlyshorterorlowerinthelaparoscopicgroup.However,theoperationtime(202.12±15.71)minutesvs.(196.32±16.73)minutes;t=1.891,P=0.061,numberoflymphnodesremoved(14.15±4.51vs.15.25±5.17;t=0.736,P=0.471),andintestinalfunctioningtime(57.88±9.70)hoursvs.(59.16±10.82)hours;t=-0.655,P=0.514werenotsignificantlydifferentbetweenthetwogroups.Therewasnosignificantdifferencebetweenthetwogroupsinthelevelofprealbuminandhemoglobin.　Conclusion　Comparedwiththetraditionalopenoperation,laparoscopicsurgeryforgastriccancerhasobviousadvantagesincludingsmallerincision,lowerbloodlossduringtheoperation,andfastrecovery,withoutaggravatingpatients′traumaticresponseorincreasingtheincidenceofoperationalcomplications.