Effect Of Laparoscopic Combined With Endoscopy In The Treatment Of Gastric Antral Cancer Between T1and T2Stage

ObjectiveUnder the application of laparoscopy combined with endoscopy technology,gastric antral cancer patients between T1and T2stage were underwentpylorus-preserving distal gastric resection with D2lymph node dissection, andcompared with traditional open surgery in operation time and per-operative bleedingand postoperative bowel function recovery time and normal tissue complicationprobability and short-term prognosis, etc. To explore the feasibility and clinicalapplication of laparoscopic combined with endoscopy surgery.MethodsTo analysis the64patients with gastric antral cancer and primary tumorsbetween T1and T2clinical data in Affiliated Tumor Hospital of ZhengzhouUniversity, General Surgery, February2012to January2013,which were met theinclusion and exclusion criteria. Depending on the surgical procedures,64patientswere divided into two groups, there were33patients underwent laparoscopiccombined endoscopy distal gastric resection and D2lymph node dissection intolaparoscopic combined with endoscopy surgery group (observation group),31patients into traditional open surgery group (control group). The digestive tractreconstruction used BillrothⅠanastomosis or Roux-en-Y gastrojejunostomy according to intraoperative conditions. Related indicators in two groups werecompared, and analyzed the differences statistically with application software.Results64patients were implemented operation successfully and no injured.33patientsin the observation group were successfully implemented laparoscopic combinedendoscopy surgical, and there was no one patient laparotomy. After initial surgicalresection specimens, the positive margin rate in observation group was0, and in thecontrol group was19.4%, the difference between the two groups was statisticallysignificant (p=0.026<0.05). There were25patients used BillrothⅠanastomosis and8patients used Roux-en-Y gastrojejunostomy to digestive tract reconstruction among33patients in the observation group, and there were24patients successfully retainedthe pylorus. In the control group, there were22used BillrothⅠanastomosis and9used Roux-en-Y gastrojejunostomy, all of them were not retained the pylorus. Therewas not significant difference between the two groups (p>0.05). The operation time inobservation group was longer than the control group, the difference was notstatistically significant (p>0.05). Per-operative bleeding and postoperative bowelfunction recovery time and length of stay in the observation group were all better thanthe control group, the difference was statistically significant (p<0.05). There were nohypercapnia and puncture injuries and subcutaneous emphysema and gas embolismcomplications of laparoscopic pneumoperitoneum in the observation group. Thepostoperative complication rate of a single species in observation group comparedwith the control group, the difference was not statistically significant (p>0.05); theoverall postoperative complications (anastomotic or closed mouth fistula andabdominal bleeding and infection and ascites intestinal obstruction) occurred in theobservation group was12.1%, significantly lower than the35.5%in the control group,the difference was statistically significant (p=0.027<0.05). After six months, theincidence rates of remnant gastritis and anastomositis in observation group were9.1%and21.2%,significantly lower than the32.3%and48.4%in the control group, thedifference was statistically significant (p<0.05). After one year the local recurrence rate and distant metastasis rate and survival in the observation group were comparedwith control group, the difference was not statistically significant (p>0.05).ConclusionThe gastric antral cancer patients which primary tumor between T1and T2stageunderwent the surgery of distal gastric resection and D2lymph node dissection andpylorus-preserving with laparoscopic combined with endoscopy. This surgicalprocedure can accelerate postoperative recovery rate and improve the quality of lifeof patients. The gastric antral cancer patients which primary tumor between T1andT2stage underwent the surgery of distal gastric resection and D2lymph nodedissection and pylorus-preserving with laparoscopic combined with endoscopy, theeffect is obvious and the surgery is feasible and safe, it is an excellent alternativesurgical.