腹腔镜胃癌根治术治疗胃神经内分泌癌疗效评价

Efficacy evaluation of laparoscopic D2 radical gastrectomy in gastric neuroendocrine carcinoma

目的探讨腹腔镜胃癌D2根治术治疗胃神经内分泌癌（GNEC）的近远期疗效及可行性。方法回顾性分析2006年1月至2012年12月间福建医科大学附属协和医院84例行胃癌D2根治术的GNEC患者的临床病理资料，其中腹腔镜手术患者（腹腔镜组）44例，开腹手术患者（开腹组）40例。对两组患者术中情况、术后恢复情况、并发症发生率、3年生存率及无复发生存时间进行比较。结果两组患者基线资料的比较，差异均无统计学意义（均P 〉 0.05）。全组患者均成功完成手术，腹腔镜组无中转开腹，手术时间与开腹组相当（P 〉 0.05）。术中出血量[ （85±21） ml比（192±89）ml，P= 0.003]、输血比例[2.3% （1 /44）比15.0% （6/40），P= 0.048]、首次下床活动时间[（2.5±1.1）d比（3.5±1.1）d，P= 0.001]、胃肠功能恢复时间[（2.9±1.1）d比（5.1±1.0）d，P= 0.001]、首次进流质时间[（4.1±1.2）d比（5.7±1.3）d，P= 0.001]及术后住院时间[（12.0±3.4）d比（15.0±5.5）d，P= 0.002]均少于开腹组，差异均有统计学意义。腹腔镜组淋巴结清扫数目为（35.0±16.4）枚，开腹组为（31.6±12.1）枚，差异无统计学意义（P= 0.204）。腹腔镜组和开腹组术后并发症发生率差异无统计学意义[11.4% （5/44）比17.5% （7/40），P= 0.422]。全组患者术后3年生存率为54.0%，腹腔镜组与开腹组比较，术后3年生存率（56.3％比51.4%，P= 0.478）和术后中位无复发生存时间（33.0月比31.5月，P= 0.703）差异均无统计学意义。结论腹腔镜胃癌D2根治术治疗GNEC具有术中出血量少和术后恢复快等优点，近、远期疗效与开腹手术相同，其治疗GNEC是可行的。

Objective To explore the feasibility and efficacy of laparoscopic D2 radical gastreetomy in patients with gastric neuroendocrine carcinoma （GNEC）. Methods Clinical data of 84 patients with GNEC undergoing laparoscopic D2 radical gastrectomy in Union Hospital from January 2006 to December 2012 were analyzed respectively. Among these patients, 44 cases underwent laparoscopic D2 gastrectomy （LAG group） and 40 cases underwent open gastreetomy （OG group）. The short- and long-term outcomes, 3-year survival and recurrence-free survival were compared between two groups. Results The LAG group and OG group did not differ significantly in terms of clinieopathologic characteristics. All the patients completed operations successfully and no patients in the LAG group ware converted to laparotomy. The operative time was similar （P 〉 0.05）. As compared to OG group, LAG group had less intra-operative blood loss [（85 ± 21） ml vs. （192 ± 89） ml, P = 0.003], lower ratio of transfusion [2.3% （1/44） vs. 15.0% （6/40）, P = 0.0481, shorter time to ambulation after surgery [（2.5 ±1.1） days vs. （3.5 ± 1.1） days, P = 0.001], faster postoperative gastrointestinal function recovery [（2.9 ±1.1） days vs. （5.1 ± 1.0） days, P = 0.001], shorter time to resume soft diet [（4.1 ±1.2） days vs. （5.7 ±1.3） days, P = 0.001] and shorter postoperative hospital stay [（12.0 ±3.4） days vs. （15.0 ± 5.5） days, P = 0.002]. No significant difference was observed in average dissected lymph node number between LAG and OG group （35.0±16.4 vs. 31.6±12.1, P = 0.204）. Morbidity of postoperative complication of LAG group and OG group was 11.4% （5/44） and 17.5% （7/40） respectively （P= 0.422）. The overall 3-year survival rate was 54.0% for all the patients, while 3-year survival rate was 56.3% in LAG group and 51.4 % in OG group （P = 0.478）. In addition, there was no significant difference in recurrence-free survival between the two group （33.0 months vs. 31.5 months, P = 0.703）. Conclusion Compared with open gastrectomy, laparoseopie D2 radical gastrectomy has the advantages of faster recovery and less blood loss, and similar short-term and long-term outcomes in treatment of patients with GNEC, thus it is a safe and feasible treatment for GNEC.