【摘要】 目的比较全腹腔镜下(total laparoscopic distal gastrectomy,TLDG)与腹腔镜辅助远端胃切除术(laparoscopy-assisted distal gastrectomy,LADG)的疗效,探讨TLDG的安全性及可行性。方法系统性回顾2012年1月～2014年12月于我院微创外科中心行手术治疗并病理确诊的胃癌患者的临床资料及随访资料,其中行LADG患者138例,TLDG患者187例。结果两组患者年龄、性别、ASA评分、CEA水平、手术方式比较差异无统计学意义(P>0. 05)。TLDG组患者在切口长度、术后住院时间、术后第1 d、第3 d疼痛评分及术后伤口感染方面均明显优于LADG组,差异均有统计学意义(P <0. 05),而两组手术时间、失血量、中转开腹例数、首次排气时间、首次进食时间、术后吻合口瘘、乳糜漏、出血及胃肠功能障碍、再手术等比较均无统计学差异(P>0. 05)。术后病理显示TLDG组患者肿瘤明显小于LADG组(P <0. 05),但两组近、远端切缘距离、淋巴结清扫数目以及pTNM分期比较,差异均无统计学意义(P> 0. 05)。LADG组中位随访时间为55(6～82)个月,TLDG组为60(10～81)个月。随访期内LADG组与TLDG组分别有15例和13例患者发生复发和(/或)远处转移,组间比较无统计学差异(P> 0. 05)。两组患者总生存期(overall survival,OS)比较亦无统计学差异(P> 0. 05)。结论在遵循恶性肿瘤手术原则的基础上,对于合适的(肿瘤较小)病例,TLDG可取得与LADG一样的治疗效果。更多还原

【Abstract】 Objective To compare the results of total laparoscopic distal gastrectomy( TLDG) and laparoscopy-assisted distal gastrectomy( LADG),and to explore the safety and feasibility of TLDG. Method From January 2012 to December 2014,the clinical data of 138 patients performed LADG and 187 patients received TLDG at the Minimally Invasive Surgery Center of Xiangya Second Hospital of Central South University were systematically reviewed. Results There was no significant difference in age,sex,ASA score,CEA level and operation mode between the two groups( P > 0. 05). The incision length,hospital stays,pain score on Day1,Day3 after the operation and wound infection rate of TLDG group were significantly better than those of LADG group( P < 0. 05). There was no statistical difference in operation time,estimated blood loss,the numbers of cases converted to laparotomy,the first exhaust time,the first feeding time,complication( as anastomotic leakage,chylous leakage,bleeding and gastrointestinal dysfunction) and reoperation between the two groups( P > 0. 05). The pathological results revealed that tumor sized was evidently less in TLDG group( P < 0. 05),but no statistical differences were found in the distal or proximal margin distance,numbers of lymph node dissection and p TNM staging between the two groups( P > 0. 05). The median follow-up time was55( 6 ～ 82) months in LADG group and 60( 10 ～ 81) months in TLDG group. During the follow-up period,no statistical difference appeared in recurrence and(/or) distant metastasis between LADG group and TLDG group( 15 vs. 13,P > 0. 05). And no significant difference existed in 5 years overall survival( OS) between the two groups( P > 0. 05). Conclusion As long as following the operation principles of malignant tumor,TLDG is safe and feasible,and it can achieve the same therapeutic effect as LADG does.更多还原