摘要
目的:对比研究腹腔镜下系统性胃系膜切除术(SME)+D2全胃切除术与标准的腹腔镜D2全胃切除术在进展期胃癌中的应用效果。方法:选取2018年1月至2020年12月70例行腹腔镜全胃切除术(LTG)治疗的进展期胃癌患者作为研究对象,采用随机数字表法将患者分SME组和标准组,每组各35例。SME组采用基于SME下腹腔镜全胃切除术+D2淋巴结清扫术;标准组采用腹腔镜全胃切除术+D2淋巴结清扫术。数据应用软件SPSS 22.0处理,患者围手术期相关指标等计量资料采用(xˉ±s)表示,行独立样本t检验;术后并发症情况等计数资料采用率(%)表示,行χ^(2)检验;生存分析采用Kaplan-Meier法并行Log-Rank检验。P<0.05表示差异有统计学意义。结果:SME组患者手术时间、术中出血量、术后首次排气时间、首次进食时间及术后住院时间显著低于标准组,淋巴结清扫数目显著高于标准组,差异均有统计学意义(P<0.05)。两组患者术后并发症的总发生率比较(20.0% vs. 14.3%),差异无统计学意义(P>0.05)。随访期间,通过Kaplan-Meier分析显示,标准组和SME组累积总生存率(68.6% vs. 85.7%)及无病生存率(65.7% vs. 82.9%)比较,差异有统计学意义(Log-Rank χ^(2)=4.068、4.587,P=0.044、0.032)。结论:与标准的D2全胃癌切除术相比,SME+D2全胃切除术不仅缩短了手术时间,减少了术中出血量,更有利于患者术后恢复,未增加手术风险的发生,而且使淋巴结清扫更彻底,更有利于提高患者预后,获得了更好的手术疗效,值得推广应用。
Objective To compare the efficacy of laparoscopic systemic mesangectomy(SME)+D2 total gastrectomy with standard laparoscopic D2 total gastrectomy in patients with advanced gastric cancer.Methods Seventy patients with advanced gastric cancer who underwent laparoscopic total gastrectomy(LTC)from January 2018 to December 2020 were selected as the study objects.The patients were divided into SME group and standard group by random number table method,with 35 cases in each group.SME group:Laparoscopic total gastrectomy+D2 lymph node dissection based on SME,standard group:laparoscopic total gastrectomy+D2 lymph node dissection.The data was processed by SPSS 22.0 software.Measurement data such as perioperative indicators were represented by(x+s),and independent sample t test was performed.The adoption rate of counting data such as postoperative complications(%),X test was performed;Survival analysis was performed by Kaplan-Meier method and Log-Rank test.P<0.05 indicated statistically significant difference.Results The operative time,intraoperative blood loss,first postoperative exhaust time,first eating time and postoperative hospital stay in SME group were significantly lower than those in standard group,and the number of lymph nodes dissection was significantly higher than that in standard group,with statistical significance(P<0.05).There was no significant difference in the total incidence of postoperative complications between the two groups(20.0%us.14.3%)(P>0.05).During the follow-up period,Kaplan-Meier analysis showed that the cumulative overall survival rate(68.6%vs.85.7%)and disease-free survival rate(65.7%vs.82.9%)between the standard group and the SME group were significantly different(Log-Rank χ^(2)=4.068,4.587,P=0.044,0.032).Conclusion Compared with the standard D2 total gastrectomy,SME+ D2 total gastrectomy not only reduces the operation time, reduces intraoperative blood loss, is moreconducive to postoperative recovery of patients, and does not increase the occurrence of surgical risks, but alsoenables more thorough dissection of lymph nodes, is more conducive to improving the prognosis of patients,and achieves better surgical efficacy, which is worthy of popularization and application.
作者
魏世东
孙劲文
Wei Shidong;Sun Jinwen(Department of General Surgery and Oncology,Emergency General Hospital,Beijing 100028,Chin)
出处
《中华普外科手术学杂志（电子版）》
2023年第2期205-208,共4页
Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)
关键词
胃肿瘤
腹腔镜
胃切除术
胃系膜切除术
D2淋巴结清扫
Stomach Neoplasms
Laparoecopes
Gastrectomy
Systematic Mesogastric Excision
D2 Lymph Node Disection
