网膜囊外剥离技术切除胃全系膜在胃癌根治术中的应用

Bursa omentalis dissection in radical gastrectomy and its clinical significance

目的:探讨胃癌根治术中应用网膜囊外剥离技术切除胃全系膜的临床意义。方法:将106例胃癌患者随机分为两组,实验组应用网膜囊外剥离技术切除胃全系膜,对照组仅行常规胃癌D2式根治术。术后对所切除标本进行病理组织学检查,判断所切除的胃系膜中是否存在癌转移,分析影响胃系膜转移的因素。并计算1、2、3年累积生存率和病死率以评估两组术式的疗效。结果:实验组手术时间较对照组延长(P<0.05),清扫的淋巴结总数明显多(P<0.01),不明显增加手术风险和并发症的发生(P>0.05)。实验组所切除的胃系膜中存在癌转移的9例(17.3%),胃癌发生系膜转移与患者肿瘤浸润深度、肿瘤大小、淋巴结转移程度等因素有关(P<0.05),而与患者年龄、性别、肿瘤位置、大体分型及病理分级无关(P>0.05)。应用网膜囊外剥离技术患者术后的1、2、3年积累生存率增加而病死率降低(P<0.05)。结论:胃癌根治术中可以根据肿块的大小及临床分期(cTNM)合理选择应用网膜囊外剥离技术切除胃全系膜。

Objective To investigate the clinical significance of mesogastrium removal by applying en-bloc resection of the omental bursa in radical excision for gastric cancer therapy. Methods 106 gastric cancer patients were enrolled and randomized into two groups. In the experimental group, the mesogastrium was removed in along with omental bursa. While in the control group, the gastric cancer D2 radical resection was performed. The surgical specimens were used for pathohistological examination to detect whether there was metastatic carcinoma in mesogastrium and to analyze the factors affecting the mesogastrium metastasis. The 1-, 2-, and 3-year survival and mortality rate was calculated to assesse the effect of the two sets of procedures. Results The operation time of the experimental group was longer than that of the control group （P 〈 0.05）, and more lymph nodes were sweptin the experimental group than those in the control group （P 〈 0.01 ）, without increase of the surgical risks and complications （P 〉 0.05）. The mesogastrium metastasis was happened in 9 patients. The metastasis was associated with tumor invasion depth, tumor size and lymphatic metastasis level （P 〈 0.05 ）, but was not associated with age, sex, tumor location, borrmann typing and pathology classification （P 〉 0.05）. The survival rate of experimental group patients was increased. Conclusion Based on the analysis of tumor size and clinical stage （cTNM）, the mesogastrium removal by appling en-bloc resection of the omental bursa can be decided in radical excision for gastric cancer therapy.