Objective To compare the effect of tumor radical resection and postoperative life quality between laparoscopic surgery and laparotomy for advanced distal gastric cancer. Method 146 cases of patients with advanced distal gastric cancer from March 2013 to March 2015 in our hospital were selected and assigned into laparoscopic group and laparotomy group by block randomization. Patients in laparoscopic group were treated with laparoscopic radical resection, patients in laparotomy group were treated with laparotomy radical resection. Compared the operation related indexes (including operation time, intraoperative blood loss, analgesic time, time to passage of flatus, the time to start eating, the time to get out of bed and postoperative hospital stay), postoperative pathological results (distance from the upper cut edge to tumor, distance from the nether cut edge to tumor, total lymph nodes cleaning), incidence of postoperative complications and postoperative life quality between the two groups. Result There was no significant difference in intraoperative blood loss between the two groups (P > 0.05). Laparoscopic group had longer operation time than laparotomy group (P < 0.01), and laparoscopic group had less analgesic time, time to passage of flatus, start eating time, time to get out of bed after surgery and postoperative hospital stay than the results in laparotomy group (P < 0.01). There were nosignificant differences on the data of the distance from the upper cut edge to tumor and the distance from the nether cut edgeto tumor between the two groups (P > 0.05), and there were no significant differences in total lymph nodes cleaning, the first station lymph nodes and the second station lymph nodes between the two groups (P > 0.05). Laparoscopic group had lower postoperative complication than laparotomy group (P < 0.01). One week after surgery, laparoscopic group had higher scores in subjective symptom, physiological function state, psychological emotional state and total points of gastrointestinal quality of life index (GLQI) than laparotomy group (P < 0.05). Three months after operation, laparoscopic group had higher scores in subjective symptom and total points of GLQI total points than laparotomy group (P < 0.05). Conclusion In the treatment of advanced distal gastric cancer, laparoscopic surgery can achieve similar effect of tumor resection and lymph node cleaning effect with laparotomy and the minimally invasive characteristic of laparoscopic surgery is helpful to speeding up postoperative recovery, reducing the postoperative complications and improving postoperative quality of life.%目的 对比分析腹腔镜手术与开腹手术对进展期远端胃癌患者肿瘤根治效果和生存质量的影响.方法 将本院2013年3月至2015年3月收治的146例进展期远端胃癌患者采用区组随机化方法分为腹腔镜组和开腹组,每组各73例.腹腔镜组患者行腹腔镜胃癌根治术,开腹组患者行开腹胃癌根治术.比较两组患者的手术相关指标(包括手术时间、术中失血量、镇痛时间、术后肛门排气时间、开始进食时间、开始下床活动时间及术后住院天数)、术后病理指标(包括上切缘与肿瘤间的距离、下切缘与肿瘤间的距离及术中淋巴结清扫数目)、术后并发症发生情况以及术后生存质量.结果 两组患者术中失血量比较无显著差异(P>0.05),腹腔镜组患者手术时间明显长于开腹组(P<0.01),但镇痛时间、术后肛门排气时间、开始进食时间、开始下床活动时间及术后住院天数均短于开腹组(P<0.01).两组患者上切缘与肿瘤间的距离、下切缘与肿瘤间的距离、淋巴结清扫数目、第一站和第二站淋巴结清扫数目比较均无显著差异(P>0.05);腹腔镜组患者术后并发症发生率明显低于开腹组(P<0.01).术后1周,腹腔镜组患者的主观症状、生理功能状态、心理情绪状态评分以及消化病生存质量指数(gastrointestinal quality of life index,GLQI)总分均高于开腹组(P<0.05).术后3个月,腹腔镜组患者的主观症状评分和GLQI总分均高于开腹组(P<0.05).结论 腹腔镜胃癌根治术治疗进展期远端胃癌,可达到与开腹胃癌根治术相近的肿瘤切除及淋巴结清扫效果,同时其微创特点有助于加快患者术后恢复、减少术后并发症,提高患者术后生存质量.
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