保留胰腺被膜的胃癌根治术治疗早期胃癌的临床疗效

Clinical Effect of Keeping The Pancreatic Capsule in Radical Gastrectomy for Early Stage of Gastric Cancer

目的探讨保留胰腺被膜的胃癌根治术治疗早期胃癌的临床疗效。方法前瞻性将笔者所在医院2011年1月到2011年12月期间收治的207例早期胃癌患者随机分为实验组95例和对照组112例，均行开腹胃癌根治术。其中实验组患者行常规胃癌根治术时不剥除胰腺被膜，对照组患者的手术按常规胃癌根治术进行。比较2组患者的临床疗效。结果实验组的术中出血量[（134．1±5．3）mL比（150．3±3．7）mL]和手术时间[（76．4±5．7）min比（87．5±9．1）min]均小于（或短于）对照组（P〈0．05），但2组患者的总并发症发生率[7．37％（7／95）比10．71％（12／112）]、吻合口漏发生率[3．16％（3／95）比4．46％（5／112）]及吻合口狭窄发生率[4．21％（4／95）比6．25％（7／112）]比较差异均无统计学意义（P〉0．05）。术后所有患者均获访，随访时间1。36个月，中位数为17．5个月。随访期间，实验组复发30例，转移23例，死亡44例；其1年和3年生存率分别为84．21％（80／95）和53．68％（51／95），1年和3年无瘤生存率分别为80．00％（76／95）和48．42％（46／95）。对照组复发37例，转移23例，死亡49例；其1年和3年生存率分别为85．71％（96／112）和56．25％（63／112），1年和3年无瘤生存率分别为81．25％（91／112）和49．11％（55／112）。2组患者的1年和3年生存率，以及1年和3年无瘤生存率比较差异均无统计学意义（P〉0．05）。此外，2组患者的生存曲线和无瘤生存曲线比较差异也均无统计学意义（P〉0．05）。结论对早期胃癌患者而言，保留胰腺被膜的胃癌根治术在术后生存率及无瘤生存率上与传统手术无明显差异，且有术中出血少、手术时间短等优点，值得进一步推广应用。

Objective To explore the clinical effect of keeping the pancreatic capsule in radical gastrectomy for early stage of gastric cancer. Methods Two hundreds and seven patients with early stage of gastric cancer who were treated in our hospital from Jan 2011 to December 2011 were enrolled prospectively, and were divided into experimental group （n=95） and control group （n=112）. Patients in experimental group kept the pancreatic capsule in radical gastrec- tomy, but patients in control group didn＇t keep the pancreatic capsule. Comparison of the clinical effect between the 2 groups was performed. Results The blood loss [ （134.1±5.3） mL vs. （150.3±3.7） mL） and operation time [ （76.4±5.7） min vs. （87.5±9.1） mini of experimental group were all lower or shorter than those of control group （P〈0.05）, but there were no significant difference between the 2 groups in incidence of total complication [ 7.37% （7/95） vs. 10.71% （12/112））, stomal leak [ 3.16% （3/95） vs. 4.46% （5/112）], and anastomotic stenosis [ 4.21% （4/95） vs. 6.25% （7/112）],P〉0.05. All of the 207 patients were followed-up for 1-36 months, with the median time of 17.5 months. During the follow-up period, in experimental group, there were 30 patients suffered from recurrence, 23 patients suffered from metastasis, and 44 patients died, and the 1- and 3-year survival rates was 84.21% （80/95） and 53.68% （51/95） respectively, 1- and 3-yeardisease free survival rates was 80.00% （76/95） and 48.42% （46/95） respectively; in control group, there were 37 patients suffered from recurrence, 23 patients suffered from metastasis, and 49 patients died, and the 1- and 3-year survival rates was 85.71% （96/112） and 56.25% （63/112） respectively, 1- and 3-year disease free survival rates was 81.25% （91/112） and 49.11% （55/112） respectively. There were no significant difference in the 1- and 3-year survival rate, 1- and 3-year disease free survival rate （P〉0.05）. In addition, there were no significant difference in the survival and disease free survival situation （P〉0.05）. Conclusions Survival and disease free survival situation of keeping the pancreatic capsule in radical gastrectomy is similar with traditionally radical gastrectomy, but surgery of keeping the pancreatic capsule in radical gastrectomy has the advantages of less bleeding and shorter operation time, which is worthy of further study.