| Background and PurposeGastric cancer is one of the most common digestive tract malignant tumor.According to figures,The incidence of gastric cancer in China is about 400,000,the second highest incidence of malignancy,and the fatality rate is about 300,000,the third highest fatality rate of malignant tumors.The incidence and mortality of gastric cancer in China account for 42.6% and 45.0% of global gastric cancer respectively,and about 80% of the new cases are advanced gastric cancer,which prognosis is relatively poor.ON account of gastric cancer causes a heavy economic burden of disease on the nation,it is very important to explore more effective treatment methods in our country.In 1994,the Japanese scholars Kitano ect first performed laparoscopic-assisted radical gastrectomy for the early gastric cancer.In1997,our country scholar first reported completed 2 cases of laparoscopic radical gastrectomy successfully.In 2002,the Japanese scholars Hashizume etc first applicated robot to treat gastric cancer,which creates a new era in the history of intelligent robot for the treatment of gastric cancer.In recent years,the enhanced recovery after surgery has been greatly deepened with the exploration of laparoscopic gastric cancer surgery.Laparoscopic radical gastrectomy gradually comes into maturity and widespread use in terms of technical operation,theoretical knowledge,and medical instrument.Nevertheless,there are many problems waited to be solved,such as the safety and efficacy of the laparoscopic radical gastrectomy in the treatment of advanced gastric cancer,the indications the laparoscopic radicalgastrectomy,the scope and number of the lymph node dissection,the rational digstive reconstruction,the technical specification of laparoscopy,and so on.Through retrospective comparative of the perioperative and early clinical effects related to laparoscope-assisted distal gastrectomy with D2 lymphadenectomy and open distal gastrectomy with D2 lymphadenectomy,this study further research and feasibility study the safety and efficacy of the laparoscopic radical gastrectomy in the treatment of advanced gastric cancer in order to proved the theory and experiment basis for the application of laparoscopic radical gastrectomy in the treatment of advanced gastric cancer.Research methodsThe data of the two groups that patients were underwent laparoscope-assisted distal gastrectomy with D2 lymphadenectomy and open distal gastrectomy with D2 lymphadenectomy during 1st of January 2013 to 31 st of December 2013 were analysed by retrospective statistical technique.There ara 39 patients were underwent laparoscope-assisted distal gastrectomy with D2 lymphadenectomy,of them 28 are males and 11 are females,with the average age(61.62±9.2)years,and there are 14 patients are T2,18 patients are T3,7 patients are T4 a.There ara 56 patients were underwent open distal gastrectomy with D2 lymphadenectomy,of them 37 are males and 19 are females,with the average age(60.39±8.7)years,and there are 13 patients are T2,37 patients are T3,6 patients are T4 a.Compare the date between the groups in areas like the operation radical index,the index of operation quality,the index of postoperative recovery and complication.The operation radical index include proximal resction margin,distal resction margin,the number of the lymph node dissection.The index of operation quality include operation duration,intraoperative blood loss,incision length.The index of postoperative recovery include first aerofluxus time,the leaving bed time,postoperative hospitalization time.The index of postoperative complication include the specific complication of laparoscopic and the complication of gastrectomy,such as pneumohypoderma,puncture wound,anastomotic fistula,anastomotic bleeding,functional delayedgastric emptying(FDGE),lymphorrhagia,incision infection,and so on.The three-year survival rate were followed up by telephone.This study used SPSS 20.0 statistical soft to statistic and analyse.ResultsThe operation time of the laparoscopy group were significantly longer than that of the open surgery group(P<0.05).However,the laparoscopy group were significantly better than the open surgery group in incision length,intraoperative blood loss,first aerofluxus time,the leaving bed time,postoperative hospitalization time(P <0.05).There were no obvious difference in proximal resction margin,distal resction margin,the number of the lymph node dissection,postoperative complication,the three-year survival rate(P > 0.05).In sum,the laparoscope-assisted distal gastrectomy with D2 lymphadenectomy is safe and effective for advanced gastric cancer,and it can get the nearly identical clinical effective as open distal gastrectomy with D2 lymphadenectomy.The laparoscope-assisted distal gastrectomy with D2 lymphadenectomy with less trauma and quicker recovery advantages,compare with open distal gastrectomy with D2 lymphadenectomy.In conclusion,it is safe and effective to treat advanced gastric cancer by the laparoscope-assisted distal gastrectomy with D2 lymphadenectomy. |
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