中间入路在Ⅲc期近端残胃癌切除术中的应用

Medial-to-lateral approach in surgical resection for proximal gastric stump carcinoma in stage Ⅲc

目的探讨中间入路原则在ⅢC期近端残胃癌应用的临床意义。方法回顾性分析解放军第一七五医院2006--2014年39例Ⅲe期近端残胃癌患者的临床资料，其中20例用中间入路行近端残胃癌切除术（A组），19例用传统路径行近端残胃癌切除术（B组）。结果A组和B组进腹后门静脉血CEA．mRNA阳性率分别为10％（2／20）和11％（2／19），差异无统计学意义（r=0．003，P〉0．05）；淋巴结清扫后两组门静脉血CEA．mRNA阳性率分别为5％（1／20）和32％（6／19），差异有统计学意义（X2=4．674，P〈0．05）；全胃切除术后两组门静脉血CEA-mRNA阳性率分别为5％（1／20）和5％（1／19），差异无统计学意义（r=0．419，P〉0．05）。两组患者术中出血量、手术时间、清扫淋巴结个数、根治性切除率、外科手术感染率、术后1—3年远处转移率、术后3年生存率分别为（2204-53）ml比（325±47）ml，t=32．930，P〈0．05；（192±24）min比（251±20）min，t=2．423，P〈0．05；（26．04-1．5）枚比（25．5±2．0）枚，t=1．982，P〉0．05；100％（20／20）比74％（14／19）X2=6．037，P〈0．05；5％（1／20）比21％（4／19），矿=11．232，P〈0．05；25％（5／20）比68％（13／19），X2=7．390，P〈0．05；70％（14／20）比37％（7／19），X2=4．310，P〈0．05。结论应用中间入路进行近端Ⅲc期残胃癌切除术能使复杂手术操作容易化，较符合胃肠道肿瘤无瘤、无菌技术原则，提高Ⅲc期近端残胃癌手术近期和远期疗效。

Objective To evaluate the clinical significance of medial-to-lateral approach in resection for proximal gastric stump carcinoma of stage Ⅲ c. Methods A total of 39 patients with stage lllc proximal gastric stump carcinoma from 2006 to 2014 at the 175th Hospital of PLA were enrolled in this study. Patients undergoing resection were divided into medial-to-lateral group （ group A, n = 20 ） and traditional approach group （group B, n = 19）. Results Before tumor resection, the positive rate of CEA mRNA expression in portal vein blood in group A and group B was 10% （2/20） and 11% （2/19） respectively （X2 = 0. 003,P 〉 0. 05）. After lymph node cleaning, the positive rate of CEA mRNA expression of groupsAand groups B was 5% （1/20）and 32% （6/19） （X2 =4.674, P〈0.05） . After tumor resection, it was 5 % （1/20） in group A and 5 % （ 1/19 ） in group B respectively （X2 = 0. 419, P 〉 0. 05 ）. Intraoperative blood less in group A was significantly less [ （220 ± 53 ） ml vs. （ 325 ±47 ） ml, t = 32. 930, P 〈 0.05 ], operative time length was shorter [ （ 192 ± 24） min vs. （251 ± 20 ） min, t = 2. 423, P 〈 0. 05 ], number of lymph node dissected was more [ （ 26 ± 1.5 ） vs. （ 25.5 ±2 ）, t = 1. 982, P 〉 0. 05 ], radical resection rate was higher [ 100% （20/20） vs. 74% （14/19） ,X2 =6. 037, P 〈0.05] ,surgical site infection rate was lower [ 5% （1/20） vs. 21% （4/19） ,X2 = 11. 232, P 〈 0. 05 ], distant metastasis rate after resection up to 3 years was lower [25% （5/20） vs. 68% （13/19）,X2 =7.390, P 〈0.05], 3 year＇s survival rate was higher [70% （14/20） vs. 37% （7/19）, X2 =4. 310, P 〈0. 05]. Conclusion Medial- to-lateral approach is a beneficial over traditional approach in radical resection for proximal gastric stump carcinoma of stage Ⅲe improving both short and long term efficacy.