| Objective: To explore the therapeutic effect and safety of Laparscopy-assisted D2 distal gastrectomy and Open D2 distal gastretomy for gastric cancer.Methods: 1.A retrospective case-control study was conducted to collect 95 cases of gastric cancer patients admitted to the Department of Gastrointestinal Surgery,Affiliated Hospital of Zunyi Medical College from January 2012 to December 2014.A total of 86 patients with gastric cancer were screened according to relevant inclusion and exclusion criteria.According to the surgical method,86 patients with gastric cancer were divided into laparoscopic group and open group.Among them,50 patients underwent laparoscopic radical gastrectomy for laparoscopic surgery,and 36 underwent radical gastrectomy for open surgery.2.Statistical analysis was performed on the age,sex,tumor stage,and number of medical diseases in the two groups.The influence of interference factors was excluded,and the data of the two groups were determined to be comparable.The operation time,intraoperative blood loss,and lymph node dissection were compared between the two groups.Number,postoperative venting time,postoperative hospital stay,postoperative complications(incisional infection,anastomotic leakage,intestinal obstruction,postoperative bleeding,delayed gastric emptying),3-year overall survival(OS)and disease-free survival Rate(DFS)and survival curve were drawn.Follow-up and telephone follow-up were used to understand the patient’s survival and tumor recurrence.The last follow-up time was December 2017.Results: 1.There was no significant difference in the age,sex,tumor stage,and number of medical diseases between the two groups(P>0.05).The average operation time(min)was222.2±30.1 in the laparoscopic group and 221.1±41.9 in the open group.The average operation time in the open group was less than that in the laparoscopic group,but the difference was not statistically significant(t=0.138 P > 0.05).The average number oflymph node dissections in the laparoscopic group was 22.5±5.1,and the open group was18.2±3.7.The number of lymph node dissection in the laparoscopic group was larger than that in the open group(t=4.306 P<0.05).The difference was statistically significant.Laparoscopy The amount of bleeding,postoperative exhaust time,and postoperative hospital stay were better than those in the open group(t=29.256、12.104、17.469,P<0.05).2.The incidence of incision infection and intestinal obstruction in the laparoscopic group was lower than that in the open group.One case(2%)of incision infection in the laparoscopic group,1 case(2%)in intestinal obstruction,and 6 cases(16.67%)incision infection in the open group.There were 5 cases(13.89)with intestinal obstruction,which were statistically significant(P<0.05).There was no statistically significant difference in anastomotic leakage,postoperative bleeding and gastric emptying(P>0.05).3.Laparoscopic group recurred 8 cases(16%),metastasis in 7 cases(14%),3-year total survival(OS)in 45 cases(90%),and disease-free survival(DFS)in 35 cases(70 cases)%);6 cases(16.67%),6 cases(16.67%),3 cases of total survival(OS),30 cases(83.33%),and disease-free survival(DFS)in 24 cases(66.67%)).There was no significant difference between the two groups(P>0.05).Conclusion: 1.Laparoscopic assisted radical gastrectomy combined with open radical gastrectomy has the advantages of less intraoperative blood loss,more thorough lymph node dissection,faster postoperative intestinal function recovery,and shorter hospital stay.2.Laparoscopically assisted radical gastrectomy has fewer postoperative complications than open radical gastrectomy.3.Laparscopy-assisted D2 distal gastrectomy is equivalent to the treatment of Open D2 distal gastretomy,and is safer than open radical gastrectomy. |
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