不同入路方案在Ⅲc期近端残胃癌患者外科手术中的应用效果

Efficacy of different operative approaches in patients with stage Ⅲc proximal gastric cancer

目的探讨传统入路和中间入路在Ⅲc期近端残胃癌患者外科手术中的应用效果。方法选取2007年3月至2016年11月间四川省成都市新都区中医医院收治的行外科手术的46例Ⅲc期近端残胃癌患者,采用随机数表法分为观察组和对照组,每组23例。对照组患者采用传统路径行近端残胃癌切除,观察组患者采用中间入路途径行近端残胃癌切除。比较两组患者手术进入腹部后、淋巴结清扫和全胃切除手术后三个时间点的门静脉血CEA-mRNA阳性率、平均出血量、手术时间和淋巴结清扫数,及术后4个月手术感染率和根治性切除率。结果观察组患者淋巴结清扫时门静脉血CEA-mRNA阳性率为4.3%,低于对照组患者的39.1%,差异有统计学意义(P<0.05)。观察组患者的平均出血量和手术时间均低于对照组患者,差异均有统计学意义(均P<0.05)。术后4个月时,观察组患者手术感染率低于对照组,根治性切除率高于对照组,差异均有统计学意义(均P<0.05)。结论中间入路方案在Ⅲc期近端残胃癌患者外科手术中应用,可有效减少术中出血和手术时间,降低外科手术感染率,提高根治切除率,值得大力推广。

Objective To compare the efficacy of conventional versus central operative approach in the surgical procedure of patients with stage Ⅲc proximal gastric cancer. Methods A total of 46 patients with stage Ⅲc proximal residual gastric cancer treated at Chengdu Xindu District Hospital of Traditional Chinese Medicine were enrolled from March 2007 to November 2016. These patients were randomly divided into an observation group and a control group according to the random number table method with 23 patients in each group. The observation group underwent resection of proximal residual gastric cancer by central operative approach and the control group underwent the surgery by conventional operative approach. The positive rate of CEA-mRNA,the average amount of bleeding,the time of operation,the number of lymph nodes after abdominal surgery,lymph node dissection and total gastrectomy,and the rate of surgical infection rate at 4 months after the operation and radical resection rate were compared between the two groups. Results The positive rate of CEA-mRNA in portal vein was 4. 3% in the observation group which was significantly lower than 39. 1% of the control group（P〈0. 05）. The average bleeding volume and operation time was lower in the observation group than in the control group（all P〈0. 05）. The infection rate was higher and radical resection rate was lower in the observation group than in the control group（all P〈0. 05）. Conclusion The resection of proximal residual gastric cancer by central operative approach can effectively reduce the bleeding,operation time and surgical infection rate and improve the resection rate in patients with stage Ⅲc proximal gastric cancer. It is worthy to be popularized.