腹腔镜与开腹保脾脾门淋巴结清扫在进展期胃中上部癌中的疗效评价

Evaluation of clinical efficacy of laparoscopic and open spleen-preserving splenic hilar lymph node dissection for advanced middle-proximal gastric cancer

目的探讨进展期胃中上部癌行腹腔镜保脾脾门淋巴结清扫术的可行性及临床疗效。方法回顾性分析行全胃切除术并D2淋巴结清扫的进展期胃中上部癌46例,其中行腹腔镜手术25例,称腹腔镜组;行开腹手术21例,称开腹组。对比2组患者术中、术后情况的差异。结果 2组患者一般临床病理资料的差异均无统计学意义。腹腔镜组淋巴结清扫数目为(28.5±9.1)枚/例,与开腹组的(27.3±8.5)枚/例相当,2组比较差异无统计学意义(P>0.05)。与开腹组相比,腹腔镜组患者术中出血量较少,脾门淋巴结清扫的时间短,术后首次下床活动时间、进食半流质时间早,且术后住院时间较短(P均<0.05);而2组患者的手术时间、肛门排气时间及进食流质时间相当(P均>0.05)。腹腔镜组术后3例发生并发症,并发症发生率为12.0%,与开腹手术的并发症发生率为19.0%相似(P>0.05);2组均无术后住院死亡病例。结论与开腹手术相比,腹腔镜保脾脾门淋巴结清扫术安全可行,具有较好的微创优势,能够达到开腹手术相当的根治效果。

Objective To investigate the feasibility and clinical efficacy of laparoscopic spleen-preservingsplenic hilar lymph node dissection for advanced middle-proximal gastric cancer. Methods Clinicaldata of 46 patients diagnosed with advanced middle-proximal gastric cancer undergoing total gastrectomy combinedwith D2 lymph node dissection were retrospectively analyzed. Twenty five patients were assigned into thelaparoscopic operation group and 21 in the open surgery group. Intraoperative and postoperative conditions werestatistically compared between two groups. Results General clinical and pathological data did not significantlydiffer between two groups. In the laparoscopic surgery group, the quantity of dissected lymph nodes was (28. 5±9. 1) for each patient, which did not considerably differ from (27. 3 ±8. 5) in the open surgery group (P >0. 0 5). Compared with the open operation group, intraoperative bleeding loss was less, the time of splenic hilarlymph node dissection was shorter, the time of postoperative out-off-bed activity was earlier, the time of intakeof semifluid diet was earlier and postoperative length of hospital stay was shorter in the laparoscopic operationgroup ( all P >0. 05 ). However, operation time, anal exsufflation time and time of eating liquid diet did notsignificantly differ between two groups (all P > 0. 05 ). In the laparoscopic group, three patients (1 2 .0 % )presented with postoperative complications, similar to that in the open surgery group ( 19. 0% ) ( P >0. 0 5 ).No patient died in two groups during hospitalization. Conclusion Compared with the open operation, laparoscopicspleen-preserving splenic hilar lymph node dissection is safe, feasible, and minimally invasive and canachieve the clinical efficacy equivalent to open surgery.