Abstract: Objective To compare the short-term clinical efficacy of totally laparoscopy radical distal gastrectomy and laparoscopy-assisted radical distal gastrectomy. Methods A prospective observational cohort study method was used to continuously include a total of 40 gastric cancer patients who underwent laparoscopic distal radical gastrectomy in our hospital from January 2021 to July 2023, including 20 cases in TLDG group and 20 cases in LADG group. The baseline data, intraoperative and postoperative conditions, and postoperative pathology of the two groups were observed and compared. Results All patients successfully completed laparoscopic radical gastrectomy for gastric cancer. The length of abdominal incision in TLDG group was significantly smaller than that in LADG group, and the difference was statistically significant （P<0.05）. There were no significant differences in operation time, gastrointestinal reconstruction time, blood loss, proximal margin length, distal resection margin length, gastrointestinal reconstruction method, intraoperative blood transfusion and intraoperative complications （P>0.05）. There was no significant difference between the two groups （P>0.05） in comparison of postoperative observational indicators, also in terms of comparison of postoperative pathology. There was one case with HER2（2+）, the rest were HER（1+） and HER（-） as. And one case （2.5%） was interpreted as dMMR by immunohistochemistry. One patient in the TLDG group drained bile-like drainage fluid from the drainage tube the day after surgery, and reoperation confirmed that the duodenal stump leaked, and cured and discharged after duodenostomy. During the follow-up period, two patients in the LADG group underwent laparoscopic partial hepatic resection half a year after surgery, one case showed metastatic moderately differentiated adenocarcinoma after surgery, considering the gastrointestinal source, intravasculature cancer thrombus was visible, and the other cases showed benign nodules with no malignant tumor. Conclusion Total laparoscopic radical distal gastrectomy is safe and effective with the small abdominal incision and cosmetic effect. It does not increase the occurrence of intraoperative and postoperative complications, and can achieve radical resection of gastric cancer.

Key words: totally laparoscopy, distal gastric cancer, radical resection

摘要： 目的 比较完全腹腔镜远端胃癌根治术与腹腔镜辅助远端胃癌根治术的近期临床疗效。方法 采用前瞻性观察性队列研究方法,连续纳入2021年1月至2023年7月在我院行腹腔镜远端胃癌根治术的胃癌患者共40例,其中TLDG组20例,LADG组20例,观察比较两组患者的基线数据、术中术后情况以及术后病理情况。结果 所有患者均顺利完成腹腔镜远端胃癌根治术,观察指标：术中情况：TLDG组腹部小切口长度明显小于LADG组,差异具有统计学意义（P<0.05）,余手术时间,消化道重建时间,失血量,近切缘长度,远切缘长度,消化道重建方式,术中是否输血及术中并发症两组比较差异均无统计学意义（均P>0.05）。术后情况：各指标两组比较差异均无统计学意义（均P>0.05）。术后病理情况：各指标两组比较差异均无统计学意义（均P>0.05）,其中HER2表达2+有1例（2.5%）,其余为阴性或者1+,经免疫组化判读为dMMR有1例（2.5%）。TLDG组有1例患者术后第二天温氏孔引流管引流出胆汁样引流液,再次手术证实为十二指肠残端漏,予行十二指肠造瘘后治愈出院。随访期间LADG组有2例患者术后半年行腹腔镜下肝部分切除术,1例术后病理示转移性中分化腺癌,考虑胃肠道来源,可见脉管内癌栓,另1例术后病理示良性结节,未见恶性肿瘤。结论 完全腹腔镜远端胃癌根治术安全有效,腹部小切口明显缩短,具有美容效果,并不增加术中及术后并发症的发生,同时能达到胃癌的根治性切除。

关键词: 完全腹腔镜, 远端胃癌, 根治术