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目的探讨腹腔镜辅助远端胃癌根治术近期效果。方法分析21例腹腔镜远端胃癌根治术临床资料,并与同期21例开腹手术资料比较。结果与开腹手术比,腔镜组切口短[(6.4±0.6)cm vs.(15.5±2.3)cm,P<0.01],手术时间长[(184.3±41.4)min vs.(168.1±22.4)min,P<0.05],术中出血量略少[(250.5±127.6)ml vs.(282.9±143.1)ml,P<0.05],术后肠功能恢复快[(86.2±10.1)h v.s(94.2±11.5)h,P<0.05]、术后住院天数少[(12.8±2.5)d v.s(16.2±3.0)d,P<0.01]。两切缘距病灶平均距离相当[(5.9±1.4)cm v.s(6.1±1.1)cm,P>0.05],但腔镜组清扫淋巴结数量少于开腹组[(16.9±2.8)个vs.(20.1±3.8)个,P<0.01)]。腔镜组费用较高[(2.98±0.29)万元vs.(2.66±0.36)万元,P<0.01]。两组皆无严重手术并发症。结论腹腔镜辅助远端胃癌根治手术安全可行、创伤小、并发症少,达到与开腹手术相同的近期效果;但淋巴结清扫有待于加强,并需降低费用。
Objective To investigate the short-term effects of laparoscopic radical gastrectomy for distal gastric cancer. Methods The clinical data of 21 cases of laparoscopic radical gastrectomy for gastric cancer were analyzed and compared with 21 cases of laparotomy during the same period. Results Compared with laparotomy, the laparoscopic group had a shorter incision [(6.4 ± 0.6) cm vs. (15.5 ± 2.3) cm, P <0.01] and a longer operation time [(184.3 ± 41.4) min vs. (168.1 ± 22.4)]. Min, P<0.05], intraoperative blood loss was slightly less [(250.5±127.6) ml vs. (282.9±143.1) ml, P<0.05], postoperative bowel function recovered faster [(86.2±10.1) h vs (94.2 ±11.5)h, P<0.05], postoperative days of hospital stay were less [(12.8±2.5) days vs 16.2±3.0 days, P<0.01]. The mean distance between the two margins from the lesion was rather [(5.9 ± 1.4) cm vs (6.1 ± 1.1) cm, P> 0.05], but the number of lymph nodes in the endoscopic group was less than that in the open group [(16.9 ± 2.8) vs. 20.1±3.8), P<0.01)]. The cost of the endoscopic group was higher [(2.98±0.29) million yuan vs. (2.66±0.36) million yuan, P<0.01]. There were no serious surgical complications in both groups. Conclusion Laparoscopic radical gastrectomy for distal gastric cancer is safe, feasible, minimally invasive, and has few complications. It has the same short-term results as open surgery. However, lymph node dissection needs to be strengthened and costs must be reduced.