摘要
目的：探讨以胰腺被膜为指引胰腺上区入路行腹腔镜胃癌根治术的临床疗效。方法：采用回顾性横断面研究方法。收集2013年4月至2017年4月吉林大学第二医院收治的438例行腹腔镜胃癌根治术患者的临床病理资料。以胰腺被膜为指引进入胰腺上区对患者行腹腔镜胃癌根治术。术后病理学分期为T2期及以上患者术后行XELOX方案辅助化疗。观察指标：（1）手术情况。（2）术后恢复情况。（3）术后病理学检查情况。（4）随访情况。采用门诊和电话方式进行随访。随访内容为患者术后辅助化疗情况、远期并发症及肿瘤转移、复发情况。随访时间截至2017年5月。正态分布的计量资料采用x±s表示。结果：（1）手术情况：438例患者均以胰腺被膜为指引进入胰腺上区行腹腔镜胃癌根治术，其中295例行远端胃癌根治术，143例行全胃切除术，无中转开腹。438例患者手术时间为（178±32）min，术中出血量为（39±11）mL，无术中并发症发生，无围术期死亡患者。（2）术后恢复情况：438例患者术后肛门首次排气时间为（32±6）h，术后首次进食流质食物时间为（26±3）h；术后第1天腹腔引流液淀粉酶含量为（157± 35）U/L、术后第2天为（68±25）U/L、术后第3天为（43±17）U/L，术后均未发生胰瘘及其他并发症；术后住院时间为（8.7±2.3）d。（3）术后病理学检查情况：438例患者术后病理学检查结果显示：肿瘤浸润深度T2期218例，T3期209例，T4a期11例；淋巴结清扫数目为（27.0±6.0）枚/例，淋巴结转移数目为（4.2± 2.9）枚/例。病理学分型：高分化或中分化腺癌67例，低分化腺癌279例，未分化癌或印戒细胞癌92例。（4）随访情况：438例患者中，415例获得术后随访，随访时间为1～48个月，中位随访时间为33个月。 293例患者接受术后XELOX方案辅助化疗，其余122例患者化疗方案不详或拒绝行化疗。随访期间无手术相关远期并发症发生，13例发生肿瘤转移或复发，5例因肿瘤复发或转移导致死亡。结论：以胰腺被膜为指引胰腺上区入路行腹腔镜胃癌根治术安全可行。
Objective：To investigate the clinical efficacy of the superior pancreatic region approach guided by pancreatic capsule in laparoscopic radical gastrectomy of 438 patients. Methods：The retrospective crosssectional study was conducted. The clinicopathological data of 438 patients who underwent laparoscopic radical gastrectomy of gastric cancer in the Second Hospital of Jilin University between April 2013 and April 2017 were collected. Patients were confirmed with stage T2 and above by postoperative pathological examination and then underwent adjuvant chemotherapy of XELOX regimen. Observation indicators： （1） surgical situation; （2） postoperative recovery situation; （3） postoperative pathological examination; （4） followup situation. Followup using outpatient examination and telephone interview was performed to detect the postoperative adjuvant chemotherapy, postoperative longterm complications and tumor metastasis or recurrence up to May 2017. Measurement data with normal distribution were represented as ±s. Results：（1） Surgical situation： all the 438 patients underwent laparoscopic radical gastrectomy of gastric cancer through the superior pancreatic region approach guided by pancreatic capsule, including 295 undergoing distal gastrectomy and 143 undergoing total gastrectomy. There were no conversion to open surgery. Operation time and volume of intraoperative blood loss were respectively （178±32） minutes and （39±11）mL. There were no intraoperative complications and death in perioperative period. （2） Postoperative recovery situation： time to anal exsufflation, time for fluid diet intake and duration of hospital stay were （32±6）hours, （26±3）hours and （8.7±2.3）days, respectively. Volume of amylase drainage was （157±35）U/L at postoperative day 1, （68±25）U/L at postoperative day 2 and （43±17）U/L at postoperative day 3, respectively. No pancreatic fistula occurred postoperatively. （3） Postoperative pathological examination： results of postoperative pathological examination showed that 218, 209 and 11 patients were detected in T2, T3 and T4a staging, respectively. Numbers of lymph node dissected and lymph node metastases were respectively 27.0±6.0 and 4.2±2.9. Pathological typing： high or moderatedifferentiated adenocarcinoma, lowdifferentiated adenocarcinoma and undifferentiated carcinoma or signetring cell carcinoma were detected in 67, 279 and 92 patients, respectively. （4） Followup situation： of 438 patients, 415 were followed up for 1-48 months, with a median time of 33 months of 438 patients, 293 received postoperative adjuvant chemotherapy of XELOX regimen, 122 received unknown adjuvant chemotherapy or refused chemotherapy. During the followup, there was no occurrence of tumorrelated complications, 13 patients had tumor metastases or recurrence and 5 patients died of tumor recurrence or metastases. Conclusion：The superior pancreatic region approach guided by pancreatic capsule is safe and feasible in laparoscopic radical gastrectomy.
作者
刘晶晶
乔小放
徐华
马志明
刘天舟
朱甲明
Liu Jingjing Qiao Xiaofang Xu Hua Ma Zhiming Liu Tianzhou Zhu Jiaming.(Department of Gastrointestinal Surgery, the Second Hospital of Jilin University, Changchun 130041, China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2017年第8期828-831,共4页
Chinese Journal of Digestive Surgery
基金
吉林省发展改革委员会项目（2016C051-2）
关键词
胃肿瘤
胰腺被膜
胃癌根治术
腹腔镜检查
Gastric neoplasms
Pancreatic capsule
Radical gastrectomy
Laparoseopy
