进展期胃癌腹腔镜根治术与开腹胃癌根治术围手术期疗效的临床研究

发布时间：2018-04-24 18:21

本文选题：进展期胃癌 + 腹腔镜　；参考：《皖南医学院》2015年硕士论文

【摘要】：目的:胃癌是人类最常见的恶性肿瘤之一,其发病率仅次于肺癌,由于饮食习惯等原因,我国胃癌每年的新发病人数约占全球每年新发胃癌病例的42%左右。胃癌的治愈的方法主要通过手术切除的方式,主要的手术方式分为:腹腔镜辅助胃癌根治术和常规开腹胃癌根治术.本临床研究旨在通过对搜集我院满足要求的患者资料进行回顾性分析研究,来探讨进展期胃癌腹腔根治术与常规胃癌根治术的围手术期疗效的对比研究。方法:对2012年6月到20013年12月间在弋饥山医院的60例II期、III期的胃癌患者进行分析研究,其中30例行腹腔镜胃癌根治患者和同期30例行传统胃癌根治患者进行分析对比研究。观察两组病例患者围手术相关指标,将传统开腹胃癌根治术患者定为对照组,将腹腔镜胃癌定为实验组,然后从几个不同的方面对两组的手术及术后情况进行对比分析,对比研究内容包括手术时间、术中出血量、清扫淋巴结的数目、肛门排气时间、开始进食时间、住院时间以及并发症。结果:两个组的手术均没有死亡的患者。腹腔镜组手术时间为(270.82±43.58)min,开腹组手术时间为(231.68±55.83)min],腹腔镜组的手术时间较开腹组长(P0.05);腹腔镜组术中出血量为(394.34±103.87)ml,开腹组为(381.12±90.45)ml,两组手术在术中的出血量上无显的差别(P0.05);腹腔镜组在肛门排气时间上(33.41±2.55)h,开腹组为(70.55±6.01)h,两组手术主要是在肛门的排气上存在差异(P0.05),腹腔镜一组的肛门排气的时间比较早;腹腔镜组的进食时间是(40.43±10.08)h,开腹组的进食时间是(73.76±5.94),这两个组的差异明显(P0.05),这个结果表明了腹腔镜的一组的胃肠道的功能恢复的比较迅速;腹腔镜组住院天数为(9.15±2.10)d,开腹组为(11.26±1.38),腹腔镜组的住院时间短并且存在差异(p0.05)。腹腔镜的淋巴结的清扫数量是(21.27±2.88)个,开腹组的清扫数量是(24.58±3.69)个,两个组的淋巴结清扫数目对比无明显差异(p0.05),表明腹腔镜胃癌根治术基本上和开腹胃癌根治术的疗效相同,其中腹腔镜组的并发症有1个,开腹组患者有2个,术中及术后死亡患者为0,两组的差异没有统计学意义(P0.05)。结论:进展期胃癌腹腔镜根治术在围手术期的疗效上基本能达到与开腹胃癌根治术相同的效果,并且腹腔镜胃癌根治术具有对患者创伤小,缩短住院时间,术后恢复快等明显优势。
[Abstract]:Objective: gastric cancer is one of the most common malignant tumors in human being. The incidence of gastric cancer is second only to lung cancer. Due to eating habits, the number of new cases of gastric cancer in China accounts for about 42% of the new cases of gastric cancer every year in the world. The cure of gastric cancer is mainly by surgical resection. The main operative methods are laparoscopic assisted radical gastrectomy and conventional open radical gastrectomy. The purpose of this clinical study was to investigate the perioperative efficacy of advanced radical gastrectomy and conventional radical gastrectomy through retrospective analysis of the data of patients with advanced gastric cancer. Methods: from June 2012 to December 20013, 60 patients with stage II or stage III gastric cancer in Gigangshan Hospital were analyzed and compared. Among them, 30 cases were treated by laparoscopic radical gastrectomy and 30 cases by traditional radical gastrectomy. The perioperative indexes of patients in two groups were observed, the patients with traditional radical operation of gastric cancer were selected as control group, and the patients with laparoscopic gastric cancer were selected as experimental group. Then the operation and postoperative conditions of the two groups were compared and analyzed from several different aspects. The comparative study included operative time, intraoperative bleeding, number of lymph nodes dissected, anal exhaust time, onset of food intake, hospital stay, and complications. Results: there was no operative death in either group. The operative time of laparoscopy group was 270.82 卤43.58 minutes, the operative time of laparotomy group was 231.68 卤55.83)min, the operative time of laparoscopy group was higher than that of laparotomy group (P 0.05), the amount of intraoperative bleeding in laparoscope group was 394.34 卤103.87 ml, and that in laparotomy group was 381.12 卤90.45 ml. The anus exhaust time of the mirror group was 33.41 卤2.55 hs, and that of the laparotomy group was 70.55 卤6.01h.There was a significant difference between the two groups in the anus exhaust time (P 0.05). The anus exhaust time of the laparoscopy group was earlier than that of the laparoscopy group. The feeding time of laparoscopy group was 40.43 卤10.08hand that of laparotomy group was 73.76 卤5.940.The difference between the two groups was significant (P 0.05), which indicated that the recovery of gastrointestinal function in one group of laparoscopy was rapid. The length of stay was 9.15 卤2.10 days in the laparoscopy group and 11.26 卤1.38 in the open group. The length of stay in the laparoscope group was short and there was a difference between the two groups (p 0.05). The number of lymph nodes dissected by laparoscopy was 21.27 卤2.88 and that in open group was 24.58 卤3.69. There was no significant difference in the number of lymph nodes dissected between the two groups (p 0.05), which indicated that the curative effect of laparoscopic radical gastrectomy was basically the same as that of open radical gastrectomy. There were 1 complication in laparoscopic group, 2 in open group and 0 in operative and postoperative death. The difference between the two groups was not statistically significant (P 0.05). Conclusion: laparoscopic radical gastrectomy for advanced gastric cancer can basically achieve the same effect as open radical gastrectomy in the perioperative period, and laparoscopic radical gastrectomy has less trauma and shorter hospitalization time for patients with gastric cancer. There were obvious advantages such as quick recovery after operation.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.2

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