目的探讨进展期胃中上部癌行腹腔镜保脾脾门淋巴结清扫术的可行性及临床疗效。方法回顾性分析行全胃切除术并D2淋巴结清扫的进展期胃中上部癌46例,其中行腹腔镜手术25例,称腹腔镜组;行开腹手术21例,称开腹组。对比2组患者术中、术后情况的差异。结果 2组患者一般临床病理资料的差异均无统计学意义。腹腔镜组淋巴结清扫数目为(28.5±9.1)枚/例,与开腹组的(27.3±8.5)枚/例相当,2组比较差异无统计学意义(P>0.05)。与开腹组相比,腹腔镜组患者术中出血量较少,脾门淋巴结清扫的时间短,术后首次下床活动时间、进食半流质时间早,且术后住院时间较短(P均<0.05);而2组患者的手术时间、肛门排气时间及进食流质时间相当(P均>0.05)。腹腔镜组术后3例发生并发症,并发症发生率为12.0%,与开腹手术的并发症发生率为19.0%相似(P>0.05);2组均无术后住院死亡病例。结论与开腹手术相比,腹腔镜保脾脾门淋巴结清扫术安全可行,具有较好的微创优势,能够达到开腹手术相当的根治效果。 Objective To investigate the feasibility and clinical efficacy of laparoscopic splenectomy and lymphadenectomy in advanced gastric cancer. Methods Retrospective analysis of total gastrectomy and D2 lymph node dissection in advanced gastric cancer in 46 cases, of which 25 cases of laparoscopic surgery, called laparoscopic group; laparotomy in 21 cases, said open group. Comparing the two groups of patients during surgery, postoperative differences. Results There was no significant difference in the general clinical pathological data between the two groups. The number of lymph node dissection in laparoscopic group was (28.5 ± 9.1) pieces / case, which was similar to that in open group (27.3 ± 8.5) pieces / case, there was no significant difference between the two groups (P> 0.05). Compared with the laparotomy group, laparoscopic group had less intraoperative blood loss, shorter splenectomy and lymph node dissection, shorter time to first bed ambulation, semi-liquid food intake, and shorter postoperative hospital stay (P <0.05). The operation time, anal exhaust time and feeding fluid time of two groups were similar (P> 0.05). Complications occurred in 3 cases after laparoscopic surgery, with a complication rate of 12.0%, which was similar to that of laparotomy (19.0%) (P> 0.05). There was no postoperative hospital mortality in both groups. Conclusion Compared with open surgery, laparoscopic splenectomy and splenic lymph node dissection is safe and feasible, has a good advantage of minimally invasive, and can achieve considerable radical effect of laparotomy.