腹腔镜与开腹手术治疗伴有出血和/或狭窄的局部晚期和转移性胃癌：短期和长期结果

腹腔镜手术已证明其在治疗早期胃癌方面的疗效。 有限的数据表明腹腔镜干预适合局部晚期胃癌。 描述腹腔镜技术治疗局部和转移性胃癌并发出血和狭窄的安全性的出版物很少。

该研究包括在 2012 年 2 月至 2018 年 8 月期间接受具有重要指征的胃切除术的经组织学证实的局部晚期和播散性胃癌并并发出血和/或狭窄的患者。腹腔镜手术（laparoscopic surgery）和开腹手术（OS）后的手术和肿瘤结果 ）进行了比较。

总共分析了 127 名患者（LS，n = 52；OS，n = 75）。 各组的基线特征相似。 总共进行了 44 例切除食管腹部的胃切除术、63 例远端小计（43 例 Billroth-I 和 20 例 Billroth-II）和 19 例近端胃切除术。 LS 组手术的中位持续时间明显更长，分别为 253 分钟（四分位数间距 [IQR]，200-295）和 210 分钟（IQR，165-220）（p < 0.001），而 LS 组的术中失血量中位数 组显著减少，180 毫升 (IQR，146-214) 对比 320 毫升 (IQR，290-350)，(p < 0.001)。 LS 组 35% 的患者和 OS 组 45% 的患者发生早期术后并发症 (p = 0.227)。 两组之间的术后死亡率没有差异（3 [6 %] 对 5 (7 %)，p = 1.00）。 腹腔镜检查后重症监护病房中位停留时间和术后住院时间中位数显著缩短，2 (IQR, 1-2) 对 4 (IQR, 3-4) 天，8 (IQR, 7-9) 对 10 (IQR, 8) –12) 天，p < 0.001。 腹腔镜检查后，患者开始辅助化疗的时间明显早于开腹手术患者，分别为 20 天和 28 天 (p < 0.001)。 然而，各组的总生存率相似。 LS 组的三年总生存率为 24%，OS 组为 27%。

尽管技术复杂，但在复杂的局部晚期和转移性胃癌患者中，与传统开腹手术相比，腹腔镜胃切除术具有更长的手术时间、减少的术中失血、更短的恢复期以及相似的发病率、死亡率和长期肿瘤学结果。

腹腔镜与开腹手术治疗伴有出血和/或狭窄的局部晚期和转移性胃癌：短期和长期结果

近端胃切除术和带抗反流袖带的食管胃造口术后的最终结果（腹腔镜视图）

腹腔镜与开腹手术治疗伴有出血和/或狭窄的局部晚期和转移性胃癌：短期和长期结果

通过 B1 准备胃十二指肠吻合术（打开视图）

腹腔镜与开腹手术治疗伴有出血和/或狭窄的局部晚期和转移性胃癌：短期和长期结果

第一排食管空肠吻合术实施后的最终结果（腹腔镜视图）

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