目的：比较全腔镜与开腹远端胃癌D2根治术的疗效及对免疫功能影响。方法：回顾性分析2009—2013年收治的远端胃癌患者的临床相关资料，按纳入及排除标准筛选出78例远端胃癌患者。38例采取全腹腔镜下D2根治术（TLDG组），40例采取开腹D2根治术（ODG组），比较两组患者的疗效与免疫功能指标。结果：与ODG组比较，TLDG组手术时间（229.3 min vs. 197.7 min）与消化道重建时间（27.6 min vs. 18.5 min）明显延长，但术中出血量（99.5 mL vs. 175.3 mL）、术后首次排气时间（3.6 d vs. 4.7 d）、术后理论出院时间（10.7 d vs. 14.7 d）均明显减少（均P<0.05）；而淋巴结清扫数目、近切缘距离、术后并发症发生率、随访率、复发转移率、2年生存率两组间差异无统计学意义（均P>0.05）；术后1、7 d所测白细胞、IL-6、CRP水平均明显降低（均P<0.05）。结论：全腹腔镜下远端胃癌根治术具有微创、对免疫功能影响小、术后恢复快的优势，是一种安全、可行、有效的手术方式。
Totally laparoscopic versus open distal radical gastrectomy with D2 dissection: the efficacy and impact on immune function
Objective: To compare the efficacy and impact on immune system of total laparoscopic and open distal radical gastrectomy with D2 dissection. Methods: The clinical data of patients with distal gastric carcinoma treated from 2009 to 2013 were retrospectively analyzed, and finally 78 cases were selected according to the inclusion and exclusion criteria. Of the patients, 38 cases underwent totally laparoscopic D2 radical gastrectomy (TLDG group), and 40 cases were operated with open distal D2 radical gastrectomy (ODG group). The parameters for efficacy and immune function between the two groups after the operation were compared. Results: In TLDG group compared with ODG group, the overall operative time (229.3 min vs. 197.7 min) and time for digestive tract reconstruction (27.6 min vs. 18.5 min) were significantly prolonged, but the intraoperative blood loss (99.5 mL vs. 175.3 mL), time to first postoperative flatus (3.6 d vs. 4.7 d), and theoretical postoperative discharge time (10.7 d vs. 14.7 d) were all significantly reduced (all P<0.05), while there was no statistical significance in the number of dissected lymph nodes, the distance of proximal margin, incidence of postoperative complications, follow-up rate, recurrence and metastasis rate, and 2-year survival rate between the two groups (all P>0.05); the white blood cell count, and IL-6 and CRP levels determined at postoperative day 1 and 7 were all significantly decreased (all P<0.05). Conclusion: Totally laparoscopic distal gastrectomy has the advantages of minimal invasiveness, less influence on immune function, and faster recovery. So it is a safe, feasible and effective procedure.