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目的探讨腹腔镜胃癌根治术治疗进展期胃癌患者的近期疗效及对腹腔内微转移的影响。方法将2012年3月—2016年3月期间浙江舟山医院肿瘤科收治的113例进展期胃癌患者按照治疗方法的不同分成腹腔镜组和开腹组。腹腔镜组行腹腔镜胃癌根治术,开腹组行传统开腹胃癌根治术。比较2组围术期指标、治疗情况、腹腔冲洗液多巴胺脱羧酶(DDC)和癌胚抗原(CEA)及并发症情况。结果腹腔镜组手术时间明显大于开腹组,差异有统计学意义(P<0.05)。腹腔镜组手术切口长度、术中出血量、注射止痛药物次数、术后肛门排气时间、首次下床活动时间、术后进食流质饮食时间、术后住院时间均显著低于对照组,差异有统计学意义(P<0.05)。腹腔镜组清扫淋巴结总数、近切端距肿瘤距离、远切端距肿瘤距离与开腹组差异无统计学意义(P>0.05)。治疗后,2组腹腔冲洗液DDC、CEA显著升高,差异有统计学意义(P<0.05),腹腔镜组腹腔冲洗液DDC、CEA显著低于开腹组,差异有统计学意义(P<0.05)。腹腔镜组术后并发症率明显低于开腹组,差异有统计学意义(P<0.05)。结论腹腔镜胃癌根治术治疗进展期胃癌手术创伤小,近期疗效确切,且未增加腹腔微转移。
Objective To investigate the short-term effect of laparoscopic radical gastrectomy on patients with advanced gastric cancer and its effect on intraperitoneal micrometastasis. Methods From March 2012 to March 2016, 113 patients with advanced gastric cancer admitted to Department of Oncology, Zhoushan Hospital of Zhejiang Province were divided into laparoscopic group and laparotomy group according to the different treatment methods. Laparoscopic group laparoscopic radical gastrectomy, laparotomy group underwent traditional open radical gastrectomy. Perioperative parameters, treatment, peritoneal washout of dopamine decarboxylase (DDC), carcinoembryonic antigen (CEA) and complications were compared between the two groups. Results The operation time of laparoscopic group was significantly larger than that of open group, the difference was statistically significant (P <0.05). The length of laparoscopic incision, intraoperative blood loss, the number of analgesic drugs injected, postoperative anal exhaust time, first ambulation time, postoperative dietary fluid intake, postoperative hospital stay were significantly lower than the control group, the difference was Statistical significance (P <0.05). There were no significant differences in the number of lymphadenectomy between the laparoscopic group and the tumor, the distance between the distal incision and the tumor and the open group (P> 0.05). After treatment, the DDC and CEA of two groups were significantly increased, the difference was statistically significant (P <0.05), DDC and CEA in laparoscopic group were significantly lower than those in open group, the difference was statistically significant (P < 0.05). The postoperative complications rate in laparoscopic group was significantly lower than that in open group, the difference was statistically significant (P <0.05). Conclusions Laparoscopic radical gastrectomy for the treatment of advanced gastric cancer has less trauma and short-term curative effect, and does not increase micrometastasis in the abdominal cavity.