The Clinical Study Of Laparoscopic-assisted Distal Gastrectomy With D2Lymphadenectomy

ObjectiveThrough the retrospective comparison of the data related to laparoscopic-assisted distalgastrectomy with D2lymphadenectomy and open distal gastrectomy with D2lymphadenectomy, research and explore the feasibility and recent clinical response oflaparoscopic-assisted distal gastrectomy with D2lymphadenectomy.Methods：Retrospectively compare the data between the two groups that patients were underwentlaparoscopic-assisted or open distal gastrectomy with D2lymphadenectomy during2011.8-2012.8. The numbers of these two groups are21and27. The specific observational datamainly includes the following aspects：1. Surgical resection radical indicators： the number of lymph node dissection， thelength of the proximal and distal resection margin from the tumor， pathological findingsand postoperative TNM staging.2. Relevant indicators of operation： the operation time， blood loss and incisionlength.3. Postoperative recovery： postoperative pain， the time of gastrointestional functionrecovery and the time of the first get out of bed.4. Postoperative complications： wound infections， lung infections and deep venousthrombosis（DVT）.Results1. Surgical resection radical indicators：Laparoscopic group compared with the open group， the difference is not statisticallysignificant(P>0.05) in number of lymph node dissection， the length of proximal and distalresection margin from tumor. It is suggested that the two surgical approach can. 2. Surgery related indicators compareThe duration of the laparoscopic group is significantly longer than the open group，thedifference is statistically significant (P<0.05). In the blood loss and incision length， thelaparoscopic group is significantly less than the open group， the difference is statisticallysignificant (P<0.05). It shows that the trauma of laparoscopic surgery was significantly lessthan open surgery， but the impact of trauma due to the extension of operation time can notbe ruled out.3. Postoperative recovery related indicators compareLaparoscopic group in VAS score， the time of gastrointestional function recovery andthe time of the first get out of bed， significantly less than the open surgery group， thedifferences are statistically significant (P<0.05). Those show the postoperative pain oflaparoscopic gastrectomy significantly lighter， and the recovery of gastrointestinal functionis significantly better.4. postoperative complicationsThe laparoscopic group postoperative wound healing significantly better than the opensurgery group， the difference is statistically significant (P<0.05). In postoperativeIncidence of lung infection and DVT， compared the two groups， the difference is notstatistically significant (P>0.05). It shows that laparoscopic gastrectomy has advantages inpromoting wound healing， and does not increase the risk of postoperative complicationssuch as lung infection and DVT.Conclusion1. Laparoscopic-assisted distal gastrectomy with D2lymphadenectomy can get almostthe same radical effect as open gastrectomy.2. Laparoscopic-assisted distal gastric D2radical mastectomy compared with opensurgery has obvious advantages of minimally. Moreover， laparoscopic surgery withoutincreasing the risk of postoperative pulmonary infection and DVT.3.As a retrospective study， it shows that the short-term treatment effect of thelaparoscopic-assisted distal gastrectomy with D2lymphadenectomy is better. But for thelong-term treatment effect，it needs multi-center clinical prospective randomized controlledstudy.