探讨局部进展期胃癌（LAGC）采用完全腹腔镜远端胃癌根治术（TLDG）的临床效果。

回顾性分析2021年5月至2023年5月LAGC患者临床资料，依据术式不同分为完全腹腔镜远端胃癌根治术组（TLDG组）和腹腔镜辅助远端胃癌根治术组（LADG组），根据一般资料采用倾向性评分匹配法对患者进行1:1匹配，TLDG组和LADG组各60例患者入组。采用SPSS 25.0软件分析数据。围手术期指标等符合正态分布的计量资料用（±s）表示，采用独立样本或配对样本t检验；分化程度等计数资料用（例）表示，采用χ²检验；生存分析采用Kaplan-Meier法，行Log-Rank检验。P<0.05为差异有统计学意义。

TLDG组患者术中出血量少于LADG组，切口长度短于LADG组（P<0.05）；TLDG组患者术后肛门排气、进食、下床活动、术后镇痛药物使用及住院时间均短于LADG组（P<0.05）；TLDG组患者术后引流管拔除时间早于LADG组，术后引流量小于LADG组（P<0.05）；术后1d，两组患者血清白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、C反应蛋白（CRP）水平均较术前升高，但TLDG组低于LADG组（P<0.05）；两组患者1年生存率比较，差异无统计学意义（P>0.05）。

TLDG治疗LAGC患者的效果较好，术中出血量少，切口长度短，术后炎症反应轻及引流量少，可缩短患者术后恢复时间、镇痛药物使用时间及引流管拔除时间。

To investigate the clinical effect of totally laparoscopic distal gastrectomy (TLDG) in the treatment of locally advanced gastric cancer (LAGC).

A retrospective analysis was performed on the clinical data of LAGC patients from May 2021 to May 2023. Patients were divided into the TLDG group and the laparoscopic-assisted distal gastrectomy (LADG) group according to different surgical methods. Propensity score matching was used for 1:1 matching based on general data, with 60 patients enrolled in each group. Data were analyzed using SPSS 25.0 software. Measurement data such as perioperative indicators were expressed as (±s), and independent sample or paired sample t tests were used; enumeration data such as differentiation degree were expressed as (cases), and χ² test was applied; survival analysis was performed by Kaplan-Meier method with Log-Rank test. P<0.05 was considered statistically significant.

The TLDG group had less intraoperative blood loss and shorter incision length than the LADG group (P<0.05). The time to postoperative anal exhaust, feeding, ambulation, postoperative analgesic use, and hospital stay in the TLDG group were all shorter than those in the LADG group (P<0.05). The drainage tube removal time in the TLDG group was earlier than that in the LADG group, and the postoperative drainage volume was smaller (P<0.05). One day after surgery, the serum levels of IL-6, CRP, and WBC in both groups increased compared with those before surgery, but were lower in the TLDG group than in the LADG group (P<0.05). There was no significant difference in 1-year survival rate between the two groups (P>0.05).

TLDG shows good efficacy in the treatment of LAGC patients, with less intraoperative blood loss, shorter incision length, milder postoperative inflammatory response, and less drainage volume. It can shorten the postoperative recovery time, analgesic use time, and drainage tube removal time.