腹腔镜下远端胃癌根治术38例临床分析(1)
【摘要】 目的：评价腹腔镜下远端胃癌根治术(LADG)治疗胃窦癌的临床推广价值。方法：采用随机对照研究，选择本院2011年12月-2013年12月76例胃窦癌患者，随机分为两组，研究组38例行腹腔镜下远端胃癌根治术，对照组38例采用传统开腹胃癌根治术，评价两组疗效及相关指标、并发症发生情况、术后复发情况等。结果：研究组平均住院时间及平均胃肠功能恢复时间均明显短于对照组(P<0.05)；平均出血量明显少于对照组(P<0.05)；平均切口长度短于对照组(P<0.05)。两组平均手术时间、清除淋巴结数目、并发症发生率比较差异无统计学意义(P>0.05)。所有患者均随访至2014年6月，研究组肝转移2例，对照组复发转移3例，死亡1例。结论：LADG安全可行，疗效肯定，创伤及副损伤小，值得临床推广应用，手术路径和淋巴清扫技术是手术成功的关键。
【关键词】 腹腔镜； 远端胃癌； 胃癌根治术； 淋巴结清扫； 手术路径
【Abstract】 Objective：To evaluate the clinical spread value of laparoscopy-assisted distal gastrectomy(LADG) in treatment of gastric antral cancer.Method：76 patients with gastric antral cancer in our hospital from December 2011 to December 2013 were randomly divided into two groups，the 38 patients in the study were given laparoscopy-assisted distal gastrectomy，38 cases in the control group were given the conventional open gastrectomy，the curative effect，related indicators，complications，postoperative recurrence and hospitalization expenses were evaluated.Result：The average hospitalization time and average time of recovery of bowel activity were significantly shorter than the control group (P<0.05).The average amount of bleeding was significantly less than that of the control group(P<0.05).The average length of incision was shorter than that of the control group(P<0.05).The average operative time，mean number of resected nodes and complications between the two groups had no statistical differences.All the patients were followed up to June 2014，2 cases in the research group appeared hepatic metastasis；In the control group，3 cases appeared recurrence and 1 case was death.Conclusion：LADG is safe and feasible for the patients with gastric antral cancer，the curative effect is positive and there is less injury，so it is well worth popularizing.The operation path and lymph node dissection are the key steps to the success of the operation.
, http://www.100md.com
【Key words】 Laparoscopy； Distal gastric cancer； Gastrectomy； Lymphadenectomy； Operation path
First-author’s address：The People’s Hospital of Yangjiang City，Yangjiang 529500，China
doi：10.3969/j.issn.1674-4985.2015.17.017
我国是胃癌大国，流行病学调查显示发生率约为33.14/10万[1]。胃癌好发于胃窦部[2]。根治性手术切除仍然是胃癌患者获得治愈的唯一途径。近年来腹腔镜胃癌手术得到了不断的发展和完善，但镜下解剖的复杂性及有别于传统开腹手术的视野和操作使手术难度增大，加上人们对腹腔镜手术能否达到与开腹手术相同的根治效果存有疑虑，也制约了腹腔镜胃癌手术的开展[3-4]。本院2011年12月-2013年12月期间为38例胃窦癌患者施行腹腔镜下远端胃癌根治术(Laparoscopy-assisted distal gastrectomy，LADG)。对该术式的可行性和价值进行探讨，现报道如下。
1 资料与方法
1.1 一般资料 选取本院2011年12月-2013年12月收治的76例胃窦癌患者，术前均经胃镜检查明确溃疡或肿物位置在胃窦部，胃镜取检：52例为腺癌，8例为印戒细胞癌，11例重度不典型增生，5例慢性溃疡。随机分为两组，研究组38例行腹腔镜下远端胃癌根治术；对照组38例采用传统开腹胃癌根治术。两组患者在年龄、性别、病理分期等方面比较差异无统计学意义(P>0.05)，具有可比性，见表1。, 百拇医药(冯疆勉 谢伟 梁文杰)
【关键词】 腹腔镜； 远端胃癌； 胃癌根治术； 淋巴结清扫； 手术路径
【Abstract】 Objective：To evaluate the clinical spread value of laparoscopy-assisted distal gastrectomy(LADG) in treatment of gastric antral cancer.Method：76 patients with gastric antral cancer in our hospital from December 2011 to December 2013 were randomly divided into two groups，the 38 patients in the study were given laparoscopy-assisted distal gastrectomy，38 cases in the control group were given the conventional open gastrectomy，the curative effect，related indicators，complications，postoperative recurrence and hospitalization expenses were evaluated.Result：The average hospitalization time and average time of recovery of bowel activity were significantly shorter than the control group (P<0.05).The average amount of bleeding was significantly less than that of the control group(P<0.05).The average length of incision was shorter than that of the control group(P<0.05).The average operative time，mean number of resected nodes and complications between the two groups had no statistical differences.All the patients were followed up to June 2014，2 cases in the research group appeared hepatic metastasis；In the control group，3 cases appeared recurrence and 1 case was death.Conclusion：LADG is safe and feasible for the patients with gastric antral cancer，the curative effect is positive and there is less injury，so it is well worth popularizing.The operation path and lymph node dissection are the key steps to the success of the operation.
, http://www.100md.com
【Key words】 Laparoscopy； Distal gastric cancer； Gastrectomy； Lymphadenectomy； Operation path
First-author’s address：The People’s Hospital of Yangjiang City，Yangjiang 529500，China
doi：10.3969/j.issn.1674-4985.2015.17.017
我国是胃癌大国，流行病学调查显示发生率约为33.14/10万[1]。胃癌好发于胃窦部[2]。根治性手术切除仍然是胃癌患者获得治愈的唯一途径。近年来腹腔镜胃癌手术得到了不断的发展和完善，但镜下解剖的复杂性及有别于传统开腹手术的视野和操作使手术难度增大，加上人们对腹腔镜手术能否达到与开腹手术相同的根治效果存有疑虑，也制约了腹腔镜胃癌手术的开展[3-4]。本院2011年12月-2013年12月期间为38例胃窦癌患者施行腹腔镜下远端胃癌根治术(Laparoscopy-assisted distal gastrectomy，LADG)。对该术式的可行性和价值进行探讨，现报道如下。
1 资料与方法
1.1 一般资料 选取本院2011年12月-2013年12月收治的76例胃窦癌患者，术前均经胃镜检查明确溃疡或肿物位置在胃窦部，胃镜取检：52例为腺癌，8例为印戒细胞癌，11例重度不典型增生，5例慢性溃疡。随机分为两组，研究组38例行腹腔镜下远端胃癌根治术；对照组38例采用传统开腹胃癌根治术。两组患者在年龄、性别、病理分期等方面比较差异无统计学意义(P>0.05)，具有可比性，见表1。, 百拇医药(冯疆勉 谢伟 梁文杰)