腹腔镜辅助全胃切除术联合D2淋巴结清扫治疗中上部进展期胃癌的疗效观察

Laparoscopic assisted total gastrectomy combined with D2 lymph node dissection in the treatment of middle and upper advanced gastric cancer

目的对比不同术式对中上部进展期胃癌(AGC)的手术效果,探讨腹腔镜辅助全胃切除术联合D2淋巴结清扫治疗中上部AGC的优势。方法回顾性分析2012年1月至2017年1月78例中上部AGC手术患者,依据术式不同分为腹腔镜辅助组(LATG组,n=40)及开腹组(OTG组,n=38),应用SPSS 20. 0软件进行统计学分析,术中术后指标及疼痛视觉模拟评分(VAS)等以均数±标准差的形式表示,采用独立t检验;术后并发症发生率及随访结果采用χ2检验; P <0. 05差异有统计学意义。结果与OTG组比较,LATG组的术中失血量明显较少,切口长度明显减小,术后首次排气时间、恢复流质进食时间、住院时间和术后1周、1个月疼痛视觉模拟评分(VAS)等明显较低,差异有统计学意义(P <0. 05),两组手术时间、淋巴结清扫数目、术后并发症发生率及术后1年总生存率差异均无统计学意义(P> 0. 05)。结论 LATG联合D2淋巴结清扫术是一种安全的手术方法,在治疗中上部AGC患者上具有术中出血量少、切口短、恢复周期短,疼痛低,不增加并发症,能达到开腹手术相当的淋巴结清扫数,近期效果较为理想,值得在临床中推广。

Objective To compare the effect of different surgical procedures on advanced gastric carcinoma （AGC） in middle and upper part, to investigate the advantages of laparoscopic assisted total gastrectomy combined with D2 lymph node dissection in the treatment of upper and middle AGC. Methods From January 2012 to January 2017, 78 patients with upper and middle AGC were treated in our hospital retrospectively and divided into the laparoscopic assisted total gastrectomy group （LATG group） and open total gastrectomy group （OTG group） according to the different operation methods. All the clinical data were statistically analyzed by SPSS 20.0 software. Related indexes of intraoperative and postoperative recovery and visual analogue score of pain were expressed in the form of mean±standard deviation. T test was used for comparison between groups. The incidence of postoperative complications and the follow-up results were expressed in the form of chi-square test. Results The intraoperative blood loss was significantly lower, the incision length was significantly smaller, and the first time of exhaust after operation was significantly lower in the LATG group than in the OTG group （ P 〈0.05）. The postoperative exhaust time, the recovering time of gastrointestinal function, the hospital stay and the visual analogue score of pain in 1 week and 1 month after operation were significantly lower （ P 〈0.05）. There were no significant difference in the operative time, the number of lymph node dissection, the incidence of postoperative complications and the overall survival rate in 1 year after operation （ P 〉0.05）. Conclusions The LATG combined with D2 lymph node dissection is safe and feasible for upper and middle AGC patients. At the same time, with less intraoperative bleeding, smaller incision, quicker recovery, no increase of complications, the number of lymph node dissection can be consistent with the open surgery, the short-term effect is more ideal, which is worth popularization in clinic.