本文選題：進展期胃癌 + 腹腔鏡��； 參考：《皖南醫(yī)學院》2015年碩士論文

【摘要】：目的:胃癌是人類最常見的惡性腫瘤之一,其發(fā)病率僅次于肺癌,由于飲食習慣等原因,我國胃癌每年的新發(fā)病人數(shù)約占全球每年新發(fā)胃癌病例的42%左右。胃癌的治愈的方法主要通過手術切除的方式,主要的手術方式分為:腹腔鏡輔助胃癌根治術和常規(guī)開腹胃癌根治術.本臨床研究旨在通過對搜集我院滿足要求的患者資料進行回顧性分析研究,來探討進展期胃癌腹腔根治術與常規(guī)胃癌根治術的圍手術期療效的對比研究。方法:對2012年6月到20013年12月間在弋饑山醫(yī)院的60例II期、III期的胃癌患者進行分析研究,其中30例行腹腔鏡胃癌根治患者和同期30例行傳統(tǒng)胃癌根治患者進行分析對比研究。觀察兩組病例患者圍手術相關指標,將傳統(tǒng)開腹胃癌根治術患者定為對照組,將腹腔鏡胃癌定為實驗組,然后從幾個不同的方面對兩組的手術及術后情況進行對比分析,對比研究內容包括手術時間、術中出血量、清掃淋巴結的數(shù)目、肛門排氣時間、開始進食時間、住院時間以及并發(fā)癥。結果:兩個組的手術均沒有死亡的患者。腹腔鏡組手術時間為(270.82±43.58)min,開腹組手術時間為(231.68±55.83)min],腹腔鏡組的手術時間較開腹組長(P0.05);腹腔鏡組術中出血量為(394.34±103.87)ml,開腹組為(381.12±90.45)ml,兩組手術在術中的出血量上無顯的差別(P0.05);腹腔鏡組在肛門排氣時間上(33.41±2.55)h,開腹組為(70.55±6.01)h,兩組手術主要是在肛門的排氣上存在差異(P0.05),腹腔鏡一組的肛門排氣的時間比較早;腹腔鏡組的進食時間是(40.43±10.08)h,開腹組的進食時間是(73.76±5.94),這兩個組的差異明顯(P0.05),這個結果表明了腹腔鏡的一組的胃腸道的功能恢復的比較迅速;腹腔鏡組住院天數(shù)為(9.15±2.10)d,開腹組為(11.26±1.38),腹腔鏡組的住院時間短并且存在差異(p0.05)。腹腔鏡的淋巴結的清掃數(shù)量是(21.27±2.88)個,開腹組的清掃數(shù)量是(24.58±3.69)個,兩個組的淋巴結清掃數(shù)目對比無明顯差異(p0.05),表明腹腔鏡胃癌根治術基本上和開腹胃癌根治術的療效相同,其中腹腔鏡組的并發(fā)癥有1個,開腹組患者有2個,術中及術后死亡患者為0,兩組的差異沒有統(tǒng)計學意義(P0.05)。結論:進展期胃癌腹腔鏡根治術在圍手術期的療效上基本能達到與開腹胃癌根治術相同的效果,并且腹腔鏡胃癌根治術具有對患者創(chuàng)傷小,縮短住院時間,術后恢復快等明顯優(yōu)勢。
[Abstract]:Objective: gastric cancer is one of the most common malignant tumors in human being. The incidence of gastric cancer is second only to lung cancer. Due to eating habits, the number of new cases of gastric cancer in China accounts for about 42% of the new cases of gastric cancer every year in the world. The cure of gastric cancer is mainly by surgical resection. The main operative methods are laparoscopic assisted radical gastrectomy and conventional open radical gastrectomy. The purpose of this clinical study was to investigate the perioperative efficacy of advanced radical gastrectomy and conventional radical gastrectomy through retrospective analysis of the data of patients with advanced gastric cancer. Methods: from June 2012 to December 20013, 60 patients with stage II or stage III gastric cancer in Gigangshan Hospital were analyzed and compared. Among them, 30 cases were treated by laparoscopic radical gastrectomy and 30 cases by traditional radical gastrectomy. The perioperative indexes of patients in two groups were observed, the patients with traditional radical operation of gastric cancer were selected as control group, and the patients with laparoscopic gastric cancer were selected as experimental group. Then the operation and postoperative conditions of the two groups were compared and analyzed from several different aspects. The comparative study included operative time, intraoperative bleeding, number of lymph nodes dissected, anal exhaust time, onset of food intake, hospital stay, and complications. Results: there was no operative death in either group. The operative time of laparoscopy group was 270.82 鹵43.58 minutes, the operative time of laparotomy group was 231.68 鹵55.83)min, the operative time of laparoscopy group was higher than that of laparotomy group (P 0.05), the amount of intraoperative bleeding in laparoscope group was 394.34 鹵103.87 ml, and that in laparotomy group was 381.12 鹵90.45 ml. The anus exhaust time of the mirror group was 33.41 鹵2.55 hs, and that of the laparotomy group was 70.55 鹵6.01h.There was a significant difference between the two groups in the anus exhaust time (P 0.05). The anus exhaust time of the laparoscopy group was earlier than that of the laparoscopy group. The feeding time of laparoscopy group was 40.43 鹵10.08hand that of laparotomy group was 73.76 鹵5.940.The difference between the two groups was significant (P 0.05), which indicated that the recovery of gastrointestinal function in one group of laparoscopy was rapid. The length of stay was 9.15 鹵2.10 days in the laparoscopy group and 11.26 鹵1.38 in the open group. The length of stay in the laparoscope group was short and there was a difference between the two groups (p 0.05). The number of lymph nodes dissected by laparoscopy was 21.27 鹵2.88 and that in open group was 24.58 鹵3.69. There was no significant difference in the number of lymph nodes dissected between the two groups (p 0.05), which indicated that the curative effect of laparoscopic radical gastrectomy was basically the same as that of open radical gastrectomy. There were 1 complication in laparoscopic group, 2 in open group and 0 in operative and postoperative death. The difference between the two groups was not statistically significant (P 0.05). Conclusion: laparoscopic radical gastrectomy for advanced gastric cancer can basically achieve the same effect as open radical gastrectomy in the perioperative period, and laparoscopic radical gastrectomy has less trauma and shorter hospitalization time for patients with gastric cancer. There were obvious advantages such as quick recovery after operation.
【學位授予單位】：皖南醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R735.2

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