T2期胃癌患者D2根治术中网膜囊剥离的临床价值评估

Clinical evaluation of the dissection of bursectomy in D2 gastrectomy of T2 gastric cancer

目的探讨T2期胃癌患者D2根治术中网膜囊剥离的风险及临床价值。 方法将86例T2期胃癌患者按随机数字表法分为网膜囊剥离组（46例）和非网膜囊剥离组（40例）。记录患者年龄、Borrman分型、肿瘤部位、分化程度、脉管癌栓、手术方式、淋巴结转移、清扫淋巴结数量、肿瘤直径、术中出血量、手术时间、术后并发症，两组患者均随访1年，观察复发、转移和生存情况。 结果两组年龄、Borrman分型、肿瘤部位、分化程度、脉管癌栓、手术方式、淋巴结转移、清扫淋巴结数量、肿瘤直径、术中出血量、术后并发症比较差异无统计学意义（P〉0.05）；横结肠系膜前叶和胰腺被膜均未发现转移；网膜囊剥离组手术时间明显长于非网膜囊剥离组[（169.13 ± 37.94）min比（147.45 ± 30.27）min]，差异有统计学意义（P〈0.05）。术后随访1年，两组均未见局部复发，网膜囊剥离组发生肝转移1例，非网膜囊剥离组发生骨转移1例；两组均无死亡病例。 结论对于T2期胃癌行D2根治术中可以不常规行网膜囊剥离，以减少手术时间、术中出血量和术后并发症发生率。

Objective To investigate the risk and value of the dissection of bursectomy in T2 gastric cancer. Methods A total of 86 T2 gastric cancer patients were divided into dissection of burseetomy group （46 cases） and non-dissection of bursectomy group （40 cases） according to the random number table method. The age, Borrman type, tumor location, degree of differentiation, vascular tumor thrombus, operation type, lymph nodes metastasis, number of dissected lymph nodes, tumor size, blood loss during operation, operation time and postoperative complications were observed. The patients were followed up for 1 year, and the local recurrence, metastasis and survive were compared between 2 groups. Results There were no statistical differences in age, Borrman type, tumor location, degree of differentiation, vascular tumor thrombus, operation type, lymph nodes metastasis, number of dissected lymph nodes, tumor size, blood loss during operation and postoperative complications （P 〉 0.05）. No metastasis was found in anterior layer of transverse eo]on and pancreatic capsule in 2 groups. The operation time in dissection of burseetomy group was significantly longer than that in non-dissection of bursectomy group： （169.13 _＋ 37.94） min vs. （147.45 _＋ 30.27） rain, and there was statistical difference （P 〈 0.05）. The patients were followed up for 1 year, and there was no local recurrence in 2 groups. There was 1 case with liver metastasis in dissection of bursectomy group, and 1 case with bony metastasis in non-dissection of bursectomy group. There was no death in 2 groups. Conclusions The dissection of burseetomy in T2 gastric cancer could be abandoned, in order to reduce the operation time, blood loss during operation, and postoperative complications.