保留迷走神经的远端胃癌根治术对早期胃癌的疗效观察

Observation of Clinical Curative Effect of Vagus Nerve-Preserving radical distal gastrectomy for early gastric cancer

目的探讨保留迷走神经的远端胃癌根治术在早期胃癌治疗中的临床应用价值。方法 47例早期胃癌患者随机分为观察组26例和对照组21例,分别观察术中出血量、手术时间、淋巴结清扫总数、术后并发症发生率、术后首次肛门排气时间和进食后腹痛发生率等变化,随访观察患者术后1、3个月的生活质量状况。结果观察组平均手术时间、平均术中出血量、平均清扫淋巴结总数和淋巴结转移率等与对照组比较无明显差异(P>0.05),术后首次肛门排气时间和食后上腹痛发生率明显低于对照组(P<0.05);术后1月观察组在吞咽困难、疼痛、返流、进食受限、躯体形象等方面的QLQ-ST022得分均明显低于对照组(P<0.05),而在术后3月,返流和吞咽困难的QLQ-ST022得分与对照组比较并无明显差异(P>0.05)。结论保留迷走神经的远端胃癌根治术在早期胃癌淋巴结清扫范围和手术安全方面是可行的、并可有效地改善患者术后近期的生活质量。

Objective To explore the clinical application value of Vagus Nerve-Preserving radical distal gastrectomy in the treatment of early gastric cancer. Methods 47 patients with early gastric cancer were randomly divided into observation group （n=26）receiving vagus nerve-preserving radical distal gastrectomy and control group（n=21） receiving traditional classic radical resec-tion;The clinic-pathological characteristics and the quality of life conditions after operative 1 ,3 months was compared between the two group. Results The observation group compared with control group,there was no significant difference in the average surgery time,the amount of hemorrhage,the number of cleaning lymph node and the rate of lymph node metastasis （P〉0.05）;The time of anal exhaust after operative and the occurrence rate of abdominal pain after eating in the observation group was lower than that of the control group;The QLQ-ST022 scores of dysphagia,abdominal pain,regurgitation,eating limited and body image of the obser-vation group one months after operation was significantly lower than that of the control group respectively （P〈0.05）,but there no significantly difference in the QLQ-ST022 scores of dysphagia and regurgitation 3 months after operation between two groups （P〉0. 05）. Conclusion Vagus Nerve-Preserving radical distal gastrectomy for early gastric cancer was feasible in the extent of lymph node dissection and operation safety, and can effectively improve the life quality of those patients after surgery.