不同腹腔冲洗方式对胃癌根治术患者预后的影响

Effects of different peritoneal lavage methods on prognosis in patients after radical gastrectomy

目的 探讨不同腹腔冲洗方式对胃癌根治术患者预后的影响.方法 选择2013年9月—2015年9月泰州市人民医院行胃癌标准D2根治术的160例患者进行前瞻性研究,按照简单随机抽签法分为试验组和对照组,每组各80例.试验组患者术中采用头低足高位,将1000 ml 37℃0.9%氯化钠溶液分4次冲洗横结肠上区的手术创面;再将体位调整为头高足低位,将2000 ml 37℃0.9%氯化钠溶液分2次全腹大量冲洗.对照组将3000 ml 37℃0.9%氯化钠溶液直接进行3次全腹大量冲洗.两组最终再分别追加1000 ml 37℃0.9%氯化钠溶液冲洗全腹腔.统计术后1年肿瘤累积复发率和生存率,分析两组追加冲洗液中癌胚抗原（CEA）mRNA表达量与复发时间的相关性.结果 术后1年,对照组有17例患者出现肿瘤复发,复发率22.97%;试验组有8例患者出现复发,复发率10.67%;两组比较差异有统计学意义（P=0.044）.术后1年,对照组患者死亡6例,生存率92.50%;试验组死亡患者5例,生存率93.75%;两组比较差异无统计学意义（P=0.755）.复发患者的追加冲洗液中CEA mRNA表达量与复发时间呈负相关,差异有统计学意义（r=-0.436,P〈0.01）.结论 局部少量多次冲洗再整体大量冲洗并结合体位调节能够减少脱落肿瘤细胞残留,降低患者术后肿瘤复发率.

Objective To explore the effects of different peritoneal lavage methods on prognosis in patients after radical gastrectomy. Methods A perspective study was carried out involving 160 patients with standardized D2 radical resection at Jiangsu Taizhou People′s Hospital from September 2013 to September 2015. All of the patients were divided into experimental group（n=80）and control group（n=80）according to the simple random lottery method. Patients in experimental group firstly adopted a position with head-down and foot-up during surgery. A total of 37 ℃ 1000 ml 0.9% sodium chloride solution were split into four times to wash the surgical wounds. And then,the position was adjusted to head-up and foot-down. A total of 37 ℃ 2000 ml 0.9% sodium chloride solution were divided into two times to wash largely in the whole abdomen. In control group,3000ml 37 ℃ 0.9% sodium chloride solution were directly divided into three times to wash largely in the whole abdomen. Finally,the appended 37 ℃ 1000 ml 0.9% sodium chloride solution were used to wash total paracentesis in both groups. The cumulative recurrence rate of tumour and survival rate one year after surgery were counted. The correlation between the mRNA expression of carcinoembryonic antigen（CEA）in the appended wash solution and the time to relapse was analyzed. Results One year after surgery,the tumor recurred in 17 patients with the recurrence rate for 22.97% in control group. The tumor recurred in 8 patients with the recurrence rate for 10.67% in experimental group. There was a statistically significant difference in tumor recurrence rate of tumour（P=0.044）. Besides,there were 6 deaths with the survival rate for 92.50% in control group along with 5 deaths with the survival rate for 93.75% in experimental group without significant difference（P=0.755）. There was a negative correlation between the mRNA expression of CEA in the appended wash solution and the time to relapse among recurrent patients（r=-0.436,P〈0.01）. Conclusions Washing with a small amount and many times along with washing with a plenty of solution as a whole combining position adjustments can reduce the residual of exfoliative tumor cells and decrease the tumour recurrence rate of patients after surgery.