腹腔镜与开腹胃癌根治术清除淋巴结的临床效果比较

Comparison of the clinical efficacy of laparoscopic and open radical gastrectomy for removal of lymph nodes

摘要:

目的 比较腹腔镜与开腹胃癌根治术在清扫淋巴结中的临床效果。方法 选取2010年10月到2015年10月铜川矿务局中心医院普外科行胃癌根治术患者753例,根据手术方式将患者分为腹腔镜胃癌根治术组(腹腔镜组)384例和常规开腹胃癌根治术组(开腹组)369例。记录并比较2组患者手术时间、出血量、切口长度、住院时间及淋巴结清扫情况。采用SPSS 19.0统计软件对数据进行处理,根据数据类型,组间比较采用独立样本t检验或χ²检验。结果 腹腔镜组患者手术时间显著大于开腹组[(275.16±32.59) vs (208.72±27.37)min,P＜0.001],但与开腹组比较,腹腔镜组患者出血量降低[(151.62±28.43) vs (319.34±98.15)ml,P＜0.001],切口长度减小[(6.35±1.47) vs (17.53±1.78)cm,P＜0.001],住院时间缩短[(9.17±3.24) vs (15.64±5.37)d,P=0.004],差异有统计学意义。腹腔镜组总清扫淋巴结9984枚,每例患者淋巴结清扫数目15~41(25.86±5.47)枚；开腹组总清扫淋巴结9372枚,每例患者淋巴结清扫数目15~46(26.47±6.12)枚。2组患者淋巴结清扫总数及每例患者清扫数目差异无统计学意义(P>0.05)。2组患者在相同的区域、肿瘤胃壁浸润深度、手术方式、肿瘤大小及分化程度间,淋巴结清除数目差异均无统计学意义(P＞0.05)。结论 在各种临床病理特征相似的条件下,腹腔镜胃癌根治术的淋巴结清扫效果与常规开腹胃癌根治术无明显差异,但前者整体手术效果优于后者。

Abstract:

Objective To compare the clinical efficacy of laparoscopic and open radical gastrectomy for the removal of lymph nodes. Methods Included in this study were 753 patients who underwent radical gastrectomy for gastric cancer in the Central Hospital of Tongchuan Mining Bureau of Shaanxi Province from October 2010 to October 2015, with 384 via laparoscopy (laparoscopic group), and 369 via laparotomy (laparotomy group). The two groups were compared in the operation time, bleeding volume, length of the incision, length of hospital stay and number of lymph node dissection. SPSS statistics 19.0 was used to process the data. Depending on the data type, independent sample t-test or Chi-square test were employed for comparison. Results The operation time in the laparoscopic group was significantly longer than that in the laparotomy group [(275.16±32.59) vs (208.72±27.37)min, P<0.001]. However, compared with the laparotomy group, the laparoscopic group had less bleeding [(151.62±28.43) vs (319.34±98.15)ml, P<0.001], shorter incision [(6.35±1.47) vs (17.53±1.78)cm, P<0.001] and shorter hospital stay [(9.17±3.24) vs (15.64±5.37)d, P=0.004], the difference being statistically significant. Lymph nodes removed totaled 9984 in the laparoscopic group with 15-41(25.86±5.47) each and 9372 in the laparotomy group with 15-46(26.47±6.12) each, without significant differences both in the total number and individual number (P>0.05). There were also no significant differences between the two groups in the number of lymph nodes removed under the similar condition in the region, depth of invasion into the gastric wall, operation method, tumor type, tumor size and degree of differentiation (P＞0.05). Conclusion With similar clinical and pathological characteristics, laparoscopic radical gastrectomy has no significantly different efficacy from laparotomy radical gastrectomy in removing lymph nodes, and the overall effect of the former is better than that of the latter in gastric cancer.