手辅助与腹腔镜辅助胃癌D2根治术的临床比较研究

A Clinical Comparative Study of Hand Assistant and Laparoscopy Assistant D2 Radical Gastrectomy for Gastric Cancer

摘要: 目的：通过比较手辅助与腹腔镜辅助胃癌D2根治术的临床近期疗效，拓展腹腔镜胃癌根治手术的技术手段。方法：回顾分析成都军区总医院胃肠外科2010年11月至2011年4月完成手辅助腹腔镜胃癌D2根治术(手辅助组)21例，以及该手术组同期完成的25例腹腔镜辅助的胃癌D2根治术(腹腔镜辅助组)的临床资料，进行比较分析。结果：手辅助组vs腹腔镜辅助组：腹腔镜下手术操作时间18~58 min(平均44 min) vs 70~100 min(平均91 min)；手术切口长度6~7 cm(平均6.81 cm) vs 5~8 cm(平均6.12 cm)；术中出血80~600 ml(平均225 ml) vs 100~500 ml(平均250 ml)。术后并发症：手辅助组，胃无力症1例；腹腔镜辅助组，术后切口感染1例；胃无力症2例。结论：手辅助腹腔镜胃癌D2根治术具有缩短腹腔镜下操作时间、降低镜下操作难度的优势，便于推广，可以作为腹腔镜胃癌D2根治术的选择术式之一，值得进一步研究。

Abstract: Purpose: Through evaluating hand assistant laparoscopic D2 radical gastrectomy, the methods of laparoscopic technique to cure gastric cancer are to be expanded. Methods: 21 cases of gastric cancer in General Hospital of Chengdu Military Region between Nov. 2010 and Apr. 2011, which underwent successfully by hand assistant laparoscopic D2 radical gastrectomy (HAL group) were reviewed and analyzed. 25 patients’ clinical data (LAT group) (operated by the same surgeon by laparoscopic assistant technique) were collected. An analysis was taken between the two groups. Result: Mean laparoscopic operating time of HAL group and LAT group was 44 min (18 - 58 min) and 91 min (70 - 100 min) respectively. Length of incision was 6.8 cm (6 - 7 cm) and 6.1 cm (5 - 8 cm) respectively. The mean blood loss was 225 ml (80 - 600) and 250 ml (100 - 500 ml) respectively. Postoperative complications: One case of gastric atony was found in hand assistant group, and two cases were found in laparoscopic group. One wound infection was found in laparoscopic group. Conclusions: Hand assistant laparoscopic D2 radical gastrectomy can shorten the laparoscopic operating time and reduce the degree of difficulty of the laparoscopic operation, which is easy to popularize. Thus it can be an alternative laparoscopic technique. The further research is needed.