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目的:探讨完全腹腔镜胃癌根治术(TLG)与腹腔镜辅助胃癌根治术的近期疗效。方法:收集2013年5月—2016年5月期间在南昌大学第二附属医院胃肠外科治疗的435例胃癌患者资料,其中207例行TLG(TLG组),228例行LAG(LAG组)。比较两组患者相关临床指标。结果:两组患者术前资料具有可比性,所有患者的手术均成功完成,无中转开腹。与LAG组比较,TLG组淋巴结清扫数目差异无统计学意义(23.64枚vs.24.69枚,P=0.14),手术时间(204.34 min vs.214.65 min)、吻合时间(33.00 min vs.38.86 min)、术中出血量(185.20 m L vs.210.02 m L)、切口长度(3.88 cm vs.8.05 cm)、术后下床活动时间(1.71 d vs.2.59 d)、肛门排气时间(2.63 d vs.3.51 d)、术后第1、3天疼痛评分(3.01分vs.4.86分;1.88分vs.3.53分)、术后住院时间(12.23 d vs.15.96 d)均明显减少(均P<0.05)。TLG组与LAG组患者术后并发症发生率(2.4%vs.2.6%,P=0.89)以及随访12个月的中位生存时间(11.07个月vs.10.91个月)均无统计学差异(均P>0.05)。结论:TLG安全、可行,且近期疗效优于LAG。
Objective: To investigate the short-term curative effect of total laparoscopic radical gastrectomy (TLG) and laparoscopic-assisted radical gastrectomy. Methods: The data of 435 patients with gastric cancer who underwent gastrointestinal surgery at the Second Affiliated Hospital of Nanchang University from May 2013 to May 2016 were collected. Among them, 207 patients received TLG (TLG group) and 228 patients received LAG (LAG group). Compare the clinical indicators of two groups of patients. Results: The preoperative data of two groups of patients were comparable, all patients were successfully completed surgery without laparotomy. Compared with LAG group, there was no significant difference in the number of lymph node dissection in TLG group (23.64 vs.24.69, P = 0.14), operation time (204.34 min vs.214.65 min), anastomosis time (33.00 min vs.38.86 min) (185.20 m L vs. 2.10.02 m L), incision length (3.88 cm vs.8.05 cm), postoperative ambulation time (1.71 d vs.2.59 d), anal exhaust time (2.63 d vs. 3.51 d). The postoperative pain scores (3.01 vs 4.86, 1.88 vs.3.53) and postoperative hospital stay (12.23 d vs.15.96 d) decreased significantly (all P <0.05) . The incidence of postoperative complications (2.4% vs 2.6%, P = 0.89) and the median survival time (11.07 months vs.10.91 months) at 12-month follow-up in both TLG and LAG groups were not statistically different All P> 0.05). Conclusion: TLG is safe and feasible, and its efficacy is better than LAG in the near future.