摘要
目的探讨腹腔镜下胃癌D2根治性手术中采用亚甲蓝示踪对于手术切除的效果及患者预后的影响作用。方法本研究采用回顾队列研究,选取2016年1月至2019年1月在新乡市中心医院实施手术治疗的160例进展期胃癌患者作为研究对象,其中84例采用腹腔镜下胃癌D2根治术+亚甲蓝标记手术(标记组),另外76例采用腹腔镜下胃癌D2根治术(对照组)。分析2组患者的术中指标、术后恢复情况、淋巴结清扫情况、术后3年累积生存率差异。结果标记组与对照组患者的年龄分别为(64.9±7.8)和(66.0±8.3)岁(P=0.389),男性分别占61.9%(52例)和55.3%(42例)(P=0.394);标记组手术时间为(218.5±19.6)min,短于对照组的(230.1±17.4)min(P<0.001)。标记组患者术中出血量、手术后肛门排气时间、术后进食时间、术后住院时间、淋巴结平均直径与对照组比较,差异均无统计学意义(均P>0.05);标记组患者清扫淋巴结总数、清扫D1淋巴结总数、清扫D2淋巴结总数均高于对照组,差异均具有统计学意义(均P<0.05);标记组手术并发症率为11.9%(10例),低于对照组的25.0%(19例)(P=0.032);标记组3年累积生存率为61.9%,与对照组的52.6%相比,差异无统计学意义(χ^(2)=3.46,P=0.065)。结论腹腔镜下胃癌D2根治性手术中采用亚甲蓝示踪有利于减少手术时间、提高淋巴结清除率、减少手术并发症。
Objective To investigate the effect of methylene blue tracing on the effect of surgical resection and the prognosis of gastric cancer patients in D2 radical surgery under laparoscope.Methods In this retrospective cohort study,160 patients with advanced gastric cancer who underwent surgical treatment in Xinxiang Central Hospital,the 4th Clinical College of Xinxiang Medical College from January 2016 to January 2019 were selected for retrospective analysis.Among them,84 patients underwent laparoscopic D2 radical gastrectomy for gastric cancer combined with methylene blue labeling operation(labeling group),and the other 76 patients underwent only laparoscopic D2 radical gastrectomy for gastric cancer(control group).The difference of intraoperative and postoperative recovery,lymph node dissection,and postoperative 3-year cumulative survival rate between the two groups were analyzed.Results The age of patients in the labeled group and the control group were(64.9±7.8)and(66.0±8.3)years old,respectively(P=0.389);And the male patients accounted for 61.9%(52 cases)and 55.3%(42 cases),respectively(P=0.394);The operation time in the labeled group was(218.5±19.6)min,which was shorter than that in the control group(230.1±17.4)min(P<0.001).There was no significant difference between the labeled group and the control group in the amount of bleeding during operation,the time of anal exhaust after operation,the time of eating after operation,the time of hospitalization after operation,and the average diameter of lymph nodes(P>0.05).The total number of dissected lymph nodes,D1 lymph nodes and D2 lymph nodes in the labeled group were significantly higher than those in the control group(all P values<0.05).The operative complication rate in the labeled group was 11.9%(10 cases),which was lower than that in the control group(25.0%,19 cases)(P=0.032);There was no statistical significance in 3-year cumulative survival rates of patients between the labeled group(61.9%)and the control group(52.6%)(χ^(2)=3.46,P=0.065).Conclusion The use of methylene blue tracing in laparoscopic D2 radical surgery for gastric cancer is beneficial to reduce the operation time,improve the lymph node clearance rate,and reduce surgical complications.
作者
杨小伟
赵宏峰
刘晓静
毕民平
胡鹏蕴
史保宾
娄萌
Yang Xiaowei;Zhao Hongfeng;Liu Xiaojing;Bi Minping;Hu Pengyun;Shi Baobin;Lou Meng(Department of General Surgery,Xinxiang Central Hospital,the Fourth Clinical College of Xinxiang Medical College,Xinxiang 453000,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2023年第6期431-435,共5页
National Medical Journal of China
关键词
腹腔镜
胃肿瘤
胃癌D2根治性术
亚甲蓝
预后
Laparoscopy
Stomach neoplasms
D2 radical operation for gastric cancer
Methylene blue
Prognosis
