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目的探讨腹腔镜手术不同术式治疗胃癌病人的安全性和远期疗效。方法采用回顾性队列研究方法,收集2009年5月至2012年12月北京大学肿瘤医院胃肠肿瘤微创外科行腹腔镜辅助胃癌根治术的210例病人的临床资料,比较不同术式病人的手术相关指标、术后恢复情况和远期疗效。结果行腹腔镜辅助远端胃大部切除术(LADG)100例、近端胃大部切除术(LAPG)35例、全胃切除(LATG)75例。3组间比较,LADG组手术时间最短,术中出血量最少,而LATG组手术时间最长,清扫淋巴结数最多。各组病人在术中输血率、中转开腹率、术后排气时间和术后住院时间方面差异均无统计学意义(均P>0.05)。在术后并发症方面,各组病人在总体并发症、手术相关并发症和系统并发症发生率方面差异无统计学意义(均P>0.05)。进一步分层分析显示,LADG组轻微并发症发生率更高,而LAPG和LATG组严重并发症发生率更高(均P<0.05)。与LADG组相比,LATG组术后再次手术率更高,差异有统计学意义(P<0.05)。LADG、LAPG和LATG组术后30 d内病死率分别为0、0和2.7%,差异无统计学意义(P>0.05)。随访43(1~80)个月,LADG、LAPG和LATG组病人术后3年总存活率分别为83.6%、67.9%和69.7%,三者比较,差异有统计学意义(χ~2=11.119,P<0.05)。仅以Ⅲ期病人行分层分析显示,LADG、LAPG和LATG组术后3年总存活率分别为67.8%、57.0%和56.1%,三者比较,差异无统计学意义(χ~2=1.893,P>0.05)。结论腹腔镜胃癌手术不同术式在手术时间、术中出血量、清扫淋巴结数和术后并发症构成方面存在差异,但术后排气时间和住院时间基本相当,LADG和LATG远期疗效与国内外文献报道相似。
Objective To investigate the safety and long-term efficacy of laparoscopic surgery for patients with gastric cancer. Methods A retrospective cohort study was conducted to collect the clinical data of 210 patients who underwent laparoscopic radical gastrectomy from May 2009 to December 2012 at the Minimally Invasive Gastrointestinal Cancer Hospital of Peking University Cancer Hospital. The clinical data of patients with different surgical procedures Related indicators, postoperative recovery and long-term efficacy. Results 100 patients underwent laparoscopic assisted distal gastrectomy (LADG), 35 underwent proximal gastrectomy (LAPG) and 75 underwent total gastrectomy (LATG). Among the three groups, LADG group had the shortest operative time and the least amount of intraoperative blood loss, while LATG group had the longest operation time and the most lymph node dissection. The blood transfusion rate, transfer to laparotomy rate, postoperative exhaust time and postoperative hospital stay in each group had no significant difference (all P> 0.05). In terms of postoperative complications, there was no significant difference in overall complication, operation-related complications and incidence of systemic complications between the two groups (all P> 0.05). Further stratified analysis showed a higher incidence of minor complications in the LADG group and a higher incidence of serious complications in the LAPG and LATG groups (all P <0.05). Compared with LADG group, LATG group had a higher rate of reoperation after surgery, the difference was statistically significant (P <0.05). The case fatality rate within 30 days after operation in LADG, LAPG and LATG groups was 0, 0 and 2.7% respectively, with no significant difference (P> 0.05). The follow-up of 43 (1-80) months showed that the 3-year overall survival rates of patients in LADG, LAPG and LATG groups were 83.6%, 67.9% and 69.7%, respectively, with significant difference between the two groups (χ ~ 2 = 11.119 , P <0.05). Stratification analysis showed that the 3-year overall survival rates of LADG, LAPG and LATG group were 67.8%, 57.0% and 56.1% respectively, with no significant difference between the three groups (χ ~ 2 = 1.893 , P> 0.05). Conclusions There are differences in operation time, intraoperative blood loss, number of lymph nodes dissected and complications after laparoscopic operation for gastric cancer surgery, but the postoperative exhaust time and hospitalization time are basically the same. The long-term efficacy of LADG and LATG is similar to that of domestic Foreign literature similar.