全腹腔镜下远端胃癌根治加三角吻合术后远期生存情况观察

Long-term survival of total laparoscopic radical distal gastrectomy with delta-shaped anastomosis

目的观察比较全腹腔镜下远端胃癌根治加三角吻合术与腹腔镜辅助远端胃癌根治加管状吻合术后的生存情况。方法回顾性分析2012年12月至2015年3月间重庆医科大学附属第一医院胃肠外科行腹腔镜远端胃癌根治加毕I式吻合术的160例患者的临床病理资料，所有患者术前均经检查明确诊断为原发性胃癌，影像学检查未发现胃癌侵犯邻近器官、远处转移和重要血管周围融合肿大的淋巴结。根据不同手术组医师对掌握手术吻合方式的不同，对其中86例患者行全腹腔镜远端胃癌根治加三角吻合术（三角吻合组），74例患者行腹腔镜辅助远端胃癌根治加管状吻合术（管状吻合组）；患者均获知情同意并签署知情同意书。随访截至2015年10月，以随访终点计算期末累计生存率。比较两组患者的临床病理资料和期末累计生存率。结果两组患者基线资料具有可比性。所有患者手术过程顺利。三角吻合组随访7～32月，随访率91％（78／86），其中11例患者死于肿瘤复发或转移，期末累计生存率为82．8％；管状吻合组随访7～33月，随访率95％（70／74），其中7例患者死于肿瘤复发或转移，期末累计生存率81．7％；两组期末累计生存率的差异无统计学意义（χ2=1．210，P：0．271）。三角吻合组与管状吻合组的I期患者均无肿瘤所致的死亡病例，Ⅱ期患者的期末累计生存率分别为87．2％和93．3％（χ2=0．426，P=0．514），Ⅲ期患者的期末累计生存率分别为65．3％和37．6％（χ2=0．718，P=0．397），差异均无统计学意义。结论全腹腔镜下远端胃癌根治加三角吻合术与腹腔镜辅助远端胃癌根治加管状吻合术后患者生存情况相近。

Objective To compare the long-term survival of total laparoscopic radical distal gastrectomy （TLDG） with delta-shaped anastomosis and laparoscopie assisted radical distal gastrectomy （LADG） with tubular anastomosis. Methods The study retrospectively analyzed the clinical and pathologic data of 160 distal gastric cancer patients who underwent laparoscopic radical distal gastreetomy with Billroth I anastomosis at the First Affiliated Hospital of Chongqing Medical University from December 2012 to March 2015. All the patients were definitively diagnosed as primary gastric carcinoma before operation, and no evidences of invasion to adjacent organs, distant metastasis or enlarged fused lymph nodes around important vessels were discovered by image tests. Eighty-six patients underwent TLDG with delta-shaped anastomosis （delta-shaped anastomosis group, DSG） and 74 patients underwent LADG with tubular anastomosis （tubular anastomosis group, TAG） in two surgery teams who had different experience of gastroduodenostomy. All the patients agreed the operation and signed informed consent. All patients followed until October 2015 when the final cumulative survival rate was counted. Survival was analyzed by Kaplan-Meier method. Results The baseline data were comparable and operations were successfully completed. Postoperative follow-up time of DSG was 7 - 32 mouths, follow-up rate was 91%（78/86）, and 11 of whom died of the gastric cancer, The cumulative survival rate by the end of the follow-up was 82.8%. Postoperative follow-up time of TAG was 7 - 33 months, follow-up rate was 95%（70/74）, 7 of whom died of the gastric cancer. The cumulative survival rate by the end of the follow-up was 81.7%. The intergroup difference of cumulative survival rate was not significant（χ2 = 1.210, P = 0.271）. No stage I patient died of gastric cancer in both groups. The cumulative survival rate by the end of the follow-up of stage Ⅱwas 87.2% vs. 93.3% （DAG vs. TAG,χ2 = 0.426, P = 0.514） ,and in stage m was 65.3% vs 37.6%（DAG vs. TAG, χ2 = 0.718, P = 0.397）, and the differences were not significant. Conclusion The TLDG with delta-shaped anastomosis and LADG with tubular anastomosis have similar long-term survival for distal gastric cancer treatment.