腹主动脉旁淋巴结清扫术治疗进展期胃癌的疗效观察

Effectiveness and safety of para-aortic nodal dissection for advanced gastric cancer

目的:比较D2+腹主动脉旁淋巴结清扫术(PAND)与D2根治术治疗进展期胃癌在疗效和安全性方面的差异。方法:纳入分析D2+PAND的胃癌根治术160例,为D2+PAND组,选择同期施行胃癌D2手术病人160例,作为对照组(D2组),比较两组并发症发生率和生存情况。结果:D2+PAND组和D2组平均手术时间分别为(329.9±102.4)min和(266.7±90.6)min,平均输血量分别为(564.7±752.5)m L和(459.3±473.4)m L,差异均有统计学意义(P<0.001)。两组并发症发生率比较差异无统计学意义。D2+PAND组和D2组平均生存期分别为(74.8±7.4)个月和(53.8±4.9)个月(P=0.105),中位生存期为36.4个月和23.4个月(P=0.123),无统计学差异。但是分层分析显示胃癌T4期病人D2+PAND组和D2组平均生存期分别为(28.1±4.6)个月和(17.2±2.8)个月,差异有统计学意义(P<0.05),对于合并第2站淋巴结转移的胃癌病人,平均生存期分别为(40.8±5.7)个月和(12.6±2.4)个月,差异有统计学意义(P<0.01)。结论:D2+PAND可改善T4期和存在第2站淋巴结转移进展期胃癌病人的预后。

Objective To evaluate the effectiveness and safety of para-aortic lymph node dissection（PAND） for the treatment of advanced gastric cancer. Methods D2 gastrectomy with PAND was performed on 160 patients with advanced gastric cancer as D2＋PAND group. The other 160 patients were subjected to the D2 operation as D2 group as control. The operative complication and the survival were compared between two groups. Results The average operation time in D2 ＋PAND group and D2 group was（329.9±102.4） min and（266.7±90.6） min respectively with the statistical difference（P0.001）. There was statistical difference of blood transfusion（564.7 ±752.5） m L in D2＋PAND group and（459.3 ±473.4） m L in D2 group（P0.001）. However, no difference of the operative complication was found between two groups. The average survival was（74.8±7.4） month in D2＋PAND group and（53.8±4.9） month in D2 group respectively（P=0.105）. The median survival was 36.4 month in D2＋PAND group and 23.4 month in D2 group（P=0.123）. It was shown with the subgroup analysis that the difference of survival was present between the patients with T4 stage [（28.1±4.6） month in D2＋PAND group vs.（17.2±2.8） month in D2 group]（P〈0.05） and the patients with second station lymph node metastasis [（40.8 ±5.7） month in D2＋PAND group vs.（12.6±2.4） month in D2 group]（P〈0.05）. Conclusions D2＋PAND may offer survival benefit to the advanced gastric cancer patients with T4 stage and with second station lymph node metastasis.