“胰腺中心解剖法”在腹腔镜辅助远端胃癌D2根治术淋巴结清扫中的应用

Pancreas-centered Anatomy in D2 Radical Lymphadenectomy in Laparoscopic-assisted Distal Gastrectomy

目的探讨"胰腺中心解剖法"在腹腔镜辅助远端胃癌D2根治术淋巴结清扫中的价值。方法回顾性分析2009年9月～2011年5月开展的20例以胰腺为解剖中心的腹腔镜辅助远端胃癌D2根治术病例资料(A组),并以2009年5月～8月同术者20例传统腹腔镜辅助远端胃癌D2根治术为对照(B组),比较2组一般资料、手术相关指数、切缘距肿瘤距离、术后恢复时间、术后生活质量评分、术后30天内并发症以及1、2年生存率。结果与B组相比,A组手术时间短[(110.3±20.1)min vs.(160.0±30.4)min,t=-6.100,P=0.000],术中出血量少[(149.6±60.4)ml vs.(332.0±104.5)ml,t=-6.757,P=0.000]。2组淋巴结清扫数目、切缘距肿瘤距离、肛门排气时间、进食时间、术后住院时间、生活质量评分以及术后30天内并发症发生率差异均无显著性(P>0.05),A组1、2年的生存率分别为54.30%、34.30%,B组为52.87%、34.30%,2组差异无显著性(χ2=0.132,P=0.717)。结论 "胰腺中心解剖法"可以缩短腹腔镜辅助远端胃癌D2根治术手术时间,减少出血。

Objective To evaluate pancreas-centered anatomy in D2 radical lymphadenectomy in laparoscopic-assisted distal gastrectomy （LADG）. Methods We reviewed the clinical data of 20 patients with distal gastric cancer, who underwent LADG with D2 lymphadenectomy by using pancreas centered anatomy in our hospital from September 2009 to May 2011 （ group A）. Another 20 patients with distal gastric cancer, who recieved LADG with D2 lymphadenectomy by using traditional methods from May 2009 to August 2009, were set as a control group （group B）. The general information, operation related indexes,distance between tumor and incisional margin, and postoperative recovering time, quality of life, rate of complications within 30 days, and 1- and 2-year survival rate were compared between the two groups. Results Compared to group B, group A showed significantly shorter operation time and lessintraoperative blood loss （110.3 ±20.1） minvs. （160.0±30.4） min, t= -6.100, P=0. 000; and （149.6±60.4） mlvs. （332.0 ±104.5） ml, t = -6. 757, P = 0. 000; respectively]. However, no significant difference was detected in the number of removed lymph nodes, distance between tumor and incisional margin, recovering time of gastrointestinal function, postoperative hospital stay and quality of life, as well as, 30-day rate of complications （ P 〉 0.05 ）. The 1- and 2-year survival rate of group A was 54.30% and 34.30% , which was not significantly different from group B （52.87% and 34.30% , X2 = 0. 132, P = 0. 717 ）. Conclusion With pancreas-centered anatomy for D2 radical lymphadenectomy, we may reduce the operation time and intraoperative blood loss of LADG.