手辅助腹腔镜胃癌根治术中逆向卷席式与卷心菜式淋巴结清扫术安全性的比较研究

Efficacy comparison of lymph node dissection patterns of the reverse and the cabbage in hand-assisted laparoscopic D2 radical gastrectomy

目的比较手辅助腹腔镜胃癌D2根治术中逆向卷席式与传统卷心菜式淋巴结清扫的临床疗效。 方法回顾性分析2010年11月至2013年10月间在成都军区总医院胃肠外科接受手辅助腹腔镜胃癌D2根治术治疗的194例胃癌患者的临床资料。全组患者采用序贯入组的方式进行分组，其中接受逆向卷席式淋巴结清扫的患者108例（逆向卷席式组，由左向右依次清扫淋巴结）；接受卷心菜式淋巴结清扫的患者86例（卷心菜式组，以腹腔干为中心，由两侧向中间清扫淋巴结）。比较两组患者围手术期疗效指标及术后短期恢复情况。 结果两组均顺利完成手术，均无围手术期死亡病例。逆向卷席式组与卷心菜式组的切口长度[（7.0±0.2）cm比（6.9±0.3） cm]、手术时间[（170.9±33.8）min比（174.6±22.4）min]、获检淋巴结数目[（17.6±7.5）枚比（17.1±5.8）枚]及术后并发症发生率[6.5%（7/108）比8.1%（7/86）]比较，差异均无统计学意义（均P〉 0.05）；但逆向卷席式组较卷心菜式组的术中出血量少[（204.6±98.2）ml比（259.1±122.6）ml，P〈 0.01] ，住院时间短[（9.0±1.7）d比（10.5±4.0）d，P〈 0.01]。随访1~6月逆向卷席式组无死亡病例，卷心菜式组1例术后48 d因上消化道大出血死亡。 结论逆向卷席式与卷心菜式淋巴结清扫术的安全性相当，但逆向卷席式淋巴结清扫术的出血少、恢复快，在手辅助腹腔镜胃癌D2根治术中应用更具优势。

ObjectiveTo compare the clinical efficacy of the lymph node dissection patterns of the reverse and the traditional cabbage in hand-assisted laparoscopic D2 radical gastrectomy （HALG）. MethodsFrom December 2010 to October 2013, 194 patients with HALG in Chengdu Military General Hospital were enrolled in this study. According to the pattern of lymph node dissection, 108 patients were performed with the reverse procedure which took spleen as starting point, from left to right, and 86 patients were performed with the traditional cabbage procedure which took the abdominal cavity as the center, from both sides to middle. A retrospective comparative analysis was made on the intra-and post-operative data between the two groups. ResultsAll the patients were successfully performed with HALG, and no peri-operative death occurred. There were no significant differences in the incision length [（7.0±0.2）cm vs. （6.9±0.3）cm], the operative time[（170.9±33.8）minute vs. （174.6±22.4）minute], dissected lymph node number （17.6±7.5 vs. 17.1±5.8）and post-operative complications [（6.5%（7/108）vs. 8.1%（7/86）]between the reverse group and cabbage group （all P 〉 0.05）. However, less blood loss [（204.6±98.2）ml vs. （259.1±122.6）ml, P 〈 0.01]and shorter postoperative hospital stay [（9.0±1.7）day vs. （10.5±4.0）day, P〈0.01] were observed in reverse group as compared to cabbage group. During 1 to 6 months follow-up, no death case was found in reverse group, while 1 case died due to upper gastrointestinal bleeding 48 days after operation in cabbage group. ConclusionEfficacy is similar between the two HALG procedures in lymph node dissection, while reverse procedure has certain advantages, such as less blood loss and faster recovery.