目的 探讨腹腔镜辅助下,全胃切除与近端胃切除治疗胃上部癌的围手术期安全性和临床疗效.方法 选取2012年1月至2015年1月期间,在解放军总医院普通外科接受腹腔镜辅助胃上部癌切除术病人130例,其中近端胃切除组53例,全胃切除组77例.收集病人临床资料,对接受两种手术方式病人的围手术期指标和临床疗效进行对比研究.结果 两组病人在年龄、性别、体质量指数(BMI)、肿瘤大小情况、病理分期、手术时间、术后住院天数等方面差异均无统计学意义(均P>0.05).在术后并发症方面,两组在切口感染、切口疝、吻合口瘘、梗阻等方面差异也无统计学意义(P>0.05),在反流性食管炎方面全胃切除组明显优于近端胃切除组(P=0.001).在术后生活质量方面,全胃切除组术后Visick分级指数明显优于近端胃组(P=0.001).结论 腹腔镜辅助全胃切除术治疗胃上部癌在术后并发症发生率方面明显优于腹腔镜辅助近端胃切除术,是治疗胃上部癌更安全有效的手术方式.%Objective To observe the short-term clinical effect and safety of laparoscopy-assisted total and subtotal gastrectomy in the treatment of proximal gastric cancer.Methods Clinical data of 130 patients with proximal gastric cancer who underwent operation in Chinese PLA General Hospital from January 2012 to January 2015 were collected and analyzed.Fifty-three patients underwent laparoscopy-assisted subtotal gastrectomy (LSG) and 77 patients underwent laparoscopy-assisted total gastrectomy (LTG).Complications and clinical efficacy in perioperative period of the two groups were compared.Results There was no statistically significant difference between the two groups with regard to gender,age,BMI,tumor size,pathological staging,intraoperative blood loss,hospital stay (P>0.05).There was no significant difference in the incidence of incision infection,incision hernia,anastomotic leakage,and obstruction between the two groups (P>0.05).However,the rate of reflux esophagitis in LTG group was higher than that in LTG group (P=0.001).With regard to life quality,the patients in the LTG group showed better outcomes on Visick level than in the LSG group (P=0.001).Conclusions The LTG shows better outcomes in the treatment of proximal gastric cancer on the incidence rate of postoperative complication,and it is a more safe and effective method for proximal gastric cancer.
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