目的分析腹腔镜辅助胃癌D2淋巴结清扫术在进展期胃癌中应用的可行性及近期疗效。方法对2010年1月至2011年12月期间在福建医科大学附属协和医院施行胃癌D2淋巴结清扫术的进展期胃癌病人,以性别、年龄、胃切除方式和浸润深度为指标,采用逐一配对法进行配对,最终296例病人纳入研究。其中,行腹腔镜手术148例(称腹腔镜组),行开腹手术148例(称开腹组)。比较两组病人的术中、术后情况及术后生存曲线的差异。结果腹腔镜组首次下床活动时间、术后肛门排气时间和进食流质时间与开腹组相似,而手术时间、术中出血量、术中输血例数、进食半流质时间和术后住院时间等均少于开腹组(P<0.05)。腹腔镜组术后并发症发生率为10.8%,明显低于开腹组的20.9%(P<0.05)。腹腔镜组与开腹组平均淋巴结清扫数目分别为(33.0±10.6)枚和(31.0±8.0)枚,差异无统计学意义(P>0.05);按胃切除方式分层分析,腹腔镜组行远端胃大部切除术的No.6淋巴结平均清扫数目显著多于开腹组(P<0.05)。其余各组别淋巴结平均清扫数目,无论是远端胃大部切除术还是全胃切除术差异均无统计学意义(P>0.05)。腹腔镜组与开腹组术后1年存活率分别为80.4%和77.7%,其生存曲线差异亦无统计学意义(P>0.05)。结论腹腔镜辅助胃癌D2淋巴结清扫术治疗进展期胃癌具有安全、术后恢复快等优点,近期疗效与开腹手术相当。 Objective To analyze the feasibility and short-term efficacy of laparoscopic-assisted D2 lymph node dissection in advanced gastric cancer. Methods From January 2010 to December 2011 in Union Hospital, Fujian Medical University, gastric cancer patients with advanced gastric cancer D2 lymph node dissection, by gender, age, gastrectomy and depth of invasion as an indicator, using one by one matching method Paired, eventually 296 patients included in the study. Among them, laparoscopic surgery in 148 cases (called laparoscopic group), laparotomy in 148 cases (called open group). The differences of intraoperative, postoperative and postoperative survival curves between the two groups were compared. Results The laparoscopic group had the first time to get out of bed, the time of postoperative anal exhaust and the time of feeding fluid were similar to those in the open group, while the operation time, intraoperative blood loss, intraoperative blood transfusion number, semi-liquid feeding time and postoperative hospital stay All were less than the open group (P <0.05). The incidence of postoperative complications in laparoscopic group was 10.8%, significantly lower than that in open group (20.9%, P <0.05). The average numbers of lymph nodes in laparoscopic group and open group were (33.0 ± 10.6) and (31.0 ± 8.0), respectively, with no significant difference (P> 0.05). According to the method of gastrectomy, laparoscopic group The average number of lymph nodes dissection in distal gastrectomy No.6 was significantly more than that in open surgery group (P <0.05). The average number of lymph nodes in other groups was no significant difference between distal gastrectomy and total gastrectomy (P> 0.05). The 1-year postoperative survival rates of laparoscopic group and open group were 80.4% and 77.7%, respectively. There was no significant difference in survival curves between laparoscopic group and open group (P> 0.05). Conclusion laparoscopic-assisted D2 lymph node dissection for advanced gastric cancer with safety, postoperative recovery advantages, the short-term efficacy and open surgery quite.