新型路径淋巴结清扫联合胃周血管阻断术治疗ⅢC期胃癌的临床疗效

Effects of novel path of lymph node dissection combined with peripheral vascular occlusion for the treatment of gastric cancer in stage ⅢC

目的 探讨新型路径淋巴结清扫联合胃周血管阻断术治疗ⅢC期胃癌的临床疗效.方法 回顾性分析2006年1月至2009年12月解放军第一七五医院收治的142例ⅢC期胃癌患者的临床资料,其中行新型路径淋巴结清扫联合胃周血管阻断术70例（联合组）、行单纯新型路径清扫淋巴结72例（单纯组）.比较两组患者术中门静脉血中CEA mRNA阳性率和术后肿瘤的远处转移率.采用门诊、住院、电话等方式进行随访,随访时间截至2013年1月.计量资料采用t检验.计数资料采用x2检验.结果 联合组和单纯组患者手术时间、术中出血量、淋巴清扫数目分别为（184±26） min、（282±80） mL、（28±5）枚和（180±28） min、（355±85） mL、（27±5）枚,两组比较,差异无统计学意义（t=0.882,5.267,0.496,P＞0.05）.联合组和单纯组患者进腹后门静脉血CEA mRNA阳性率分别为10.0％ （7/70）和9.7％（7/72）,两组比较,差异无统计学意义（x2=0.003,P＞0.05）;淋巴结清扫后CEA mRNA阳性率分别为2.9％ （2/70）和16.7％（12/72）,两组比较,差异有统计学意义（x2=8.240,P＜0.05）;全胃切除术后CEA mRNA阳性率分别为4.3％（3/70）和4.2％（3/72）,两组比较,差异无统计学意义（x2=0.001,P＞0.05）.术后1年两组患者均获随访,术后3年139例患者获得随访,中位随访时间为33.5个月（12.0 ～42.0个月）.联合组和单纯组患者术后1年肿瘤远处转移率分别为7.1％ （5/70）和8.3％（6/72）,两组比较,差异无统计学意义（x2=0.070,P＞0.05）;联合组和单纯组患者术后3年肿瘤远处转移率分别为33.3％（23/69）和51.4％（36/70）,两组比较,差异有统计学意义（x2=4.660,P＜0.05）;联合组和单纯组患者远处实质器官转移率分别为10.1％（7/69）和44.3％（31/70）,两组比较,差异有统计学意义（x2=20.390,P＜0.05）.结论 新型路径淋巴结清扫联合胃周血管阻断术能及时阻断ⅢC期胃癌根治性全胃切除术中胃癌细胞随淋巴和血液回流,有效减少术中癌细胞的远处播散和降低肿瘤术后远期转移率.

Objective To investigate the clinical efficacy of a novel path of lymph node dissection combined with peripheral vascular occlusion for the treatment of gastric cancer in stage ⅢC.Methods The clinical data of 142 patients with gastric cancer in stage Ⅲ C who were admitted to the 175th Hospital of PLA from January 2006 to December 2009 were retrospectively analyzed.Seventy patients received novel path of lymph node dissection combined with peripheral vascular occlusion （combined group） and 72 patients received simple lymph node dissection via the novel path （simple group）.The positive rate of mRNA expression of carcinoembryonic antigen （CEA） and the distal metastatic rate of tumor cells between the 2 groups were compared.Patients were followed up via outpatient examination,phone call and in-patient examination till January 2013.The measurement data and the enumeration data were analyzed using the t test and the chi-square test,respectively.Results The operation time,volume of blood loss and number of lymph nodes dissected were （184 ± 26） minutes,（282 ± 80） mL and 28 ± 5 in the combined group,（180 ± 28）minutes,（355 ± 85）mL and 27 ± 5 in the simple group,with no significant difference between the 2 groups （t =0.882,5.267,0.496,P ＞ 0.05）.The positive rates of mRNA expression of CEA of the combined group and the simple group were 10.0％ （7/70） and 9.7％ （7/72）,with no significant difference between the 2 groups （x2 =0.003,P ＞ 0.05）.The positive rates of mRNA expression of CEA after lymph node dissection of the combined group and the simple group were 2.9％ （2/70） and 16.7％ （12/72）,with significant difference between the 2 groups （x2 =8.240,P ＜ 0.05）.The positive rates of mRNA expression of CEA after total gastrectomy of the combined group and the simple group were 4.3％ （3/70） and 4.2％ （3/72）,with no significant difference between the 2 groups （x2=0.001,P ＞ 0.05）.All patients were followed up at postoperative year 1,and 139 patients were followed up at postoperative year 3.The median time of follow-up was 33.5 month （range,12.0-42.0 month）.The 1-year distal metastatic rate of the combined group and the simple group were 7.1％ （5/70） and 8.3％ （6/72）,with no significant difference between the 2 groups （x2=0.070,P ＞0.05）.The 3-year distal metastatic rate of the combined group and the simple group were 33.3％ （23/69） and 51.4％ （36/70）,with significant difference between the 2 groups （x2=4.660,P ＜0.05）.The distal metastatic rates of distal parenchymatous organs of the combined group and the simple group were 10.1％ （7/69） and 44.3％ （31/70）,with significant difference between the 2 groups （x2=20.390,P ＜ 0.05）.Conclusions Novel path of lymph node dissection combined with peripheral vascular occlusion can block the lymph node and blood backflow,and thus effectively reduces the distal metastatic rate of gastric cancer in stage ⅢC after operation.