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。 共进行了 44 例食管腹部切除术、63 例远端胃切除术（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。

胃癌是全球第四大癌症死亡原因和第五大常见癌症。 尽管近年来其发病率和死亡率有所下降，但 2020 年新增确诊病例超过 100 万，估计有 76.9 万人死于胃癌。 预后主要取决于诊断时的疾病分期； 由于患者通常被诊断为局部晚期或转移，因此预后较差。 由于大多数西方国家缺乏筛查计划，胃癌的晚期检测很常见，并且常常并发出血和/或狭窄。 在出现这些并发症的情况下，目前的指南并未提供最终的标准化方法。 这些患者中的绝大多数接受姑息治疗或对症治疗，只有大约四分之一的病例可以进行根治性手术。

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

图 1
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

图 2
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

图 3
第一排食管空肠吻合术实施后的最终结果（腹腔镜视图）

获得的数据表明，尽管技术复杂，但在复杂的局部晚期和转移性胃癌患者中，腹腔镜胃切除术与更长的手术时间、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相关。 与传统开放手术相比的结果。 根据系列建议尽可能采用腹腔镜方法对这组患者进行胃切除术。

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