进展期胃上部癌胰上网膜囊背侧两种不同清扫途径对比研究

Comparison of two different ways of radical resection of bursa omentalis above the pancreas for advanced proximal gastric cancer

目的对比左侧与右侧两种清扫途径在进展期胃上部癌胰上网膜囊背侧的安全性及疗效。方法回顾性分析2009年3月-2015年11月江苏省溧阳市人民医院102例采用D2淋巴结清扫术的进展期胃上部癌患者的临床资料。其中53例患者左侧途径,49例患者右侧途径。比较两种不同途径术中、术后及并发症旳情况。结果左侧途径手术在完成时间、出血量、术后淋巴漏发生等指标优于起始途径;其中术后淋巴漏发生无统计学意义。淋巴结清扫数目、术后肛门排气时间、术后进流质饮食时间、术后住院时间无统计学意义。结论清扫胰上网膜囊背侧是进展期胃上部癌患者D2淋巴结清扫术中的重要环节,其中左侧途径手术在清扫时间、出血量、术后淋巴漏发生上具有一定优势、值得推广,是一种安全、简便的手术入路。

Objective To compare the perioperative safety and efficacy between left initial pathway and right initial pathway of radical resection of bursa omentalis above the pancreas for advanced proximal gastric cancer. Methods The clinical data of 102 patients who underwent D2 lymphadenectomy for advanced proximal gastric cancer at People＇s Hospital of Liyang Jiangsu from March 2009 to November2015 were retrospectively analyzed. Fifity cases were performed radical resection by left initial pathway and 49 by right initial pathway. The intraoperative outcomes between the two groups were compared.Results Compared with right initial pathway,left initial pathway had shorter operation time,less intraoperative blood loss,and lower morbidity of postoperative lymphatic fistulas. There were no significant differences in the number of lymph node removed,time to anal exsufflation,time for fluid diet intake and time duration of hospital stay between the two groups. Conclusion Radical resection of bursa omentalis is very important for D2 lymphadenectomy for advanced proximal gastric cancer. Left initial pathway has advantage in the shorter operation time, less intraoperative blood loss, and lower morbidity of postoperative lymphatic fistulas. the pathway is safe、convenient and could be popularized。