腹腔镜与开腹保脾脾门淋巴结清扫术的临床价值比较

Comparison of Laparoscopic and Open Spleen-Preserving Splenic Hilar Lymph Node Dissection

目的比较腹腔镜与开腹手术在进展期胃中上部癌患者保脾脾门淋巴结清扫术中的临床价值。方法回顾性分析2017年5—12月在安徽省肿瘤医院行全胃切除术并D2淋巴结清扫术的进展期胃中上部癌患者的临床资料。根据术式分为A组和B组,其中A组28例行腹腔镜手术,B组24例行开腹手术。比较2组手术相关指标(包括手术时间、术中出血量、淋巴结清扫数目、脾门淋巴结清扫数目、脾门淋巴结清扫时间、首次下床时间等)、术后并发症发生率(包括吻合口瘘、腹腔感染、肠梗阻、肺部感染等),观察2组术前及术后6个月血清CEA、CA-199水平变化情况。结果A组术中出血量、脾门淋巴结清扫时间及首次下床时间均显著低于B组(P<0.05),2组手术时间、淋巴结清扫数目及脾门淋巴结清扫数目比较差异均无统计学意义(P>0.05)。2组均无住院死亡病例;A组术后并发症发生率为10.71%(3/28),B组为16.67%(4/24),2组比较差异无统计学意义(χ2=0.393,P=0.690)。2组术后6个月血清CEA及CA-199水平均显著低于治疗前(P<0.05),且A组术后6个月血清CEA及CA-199的水平均明显低于同期B组(P<0.05)。结论行进展期胃中上部癌根治性全胃切除术时,选择腹腔镜保脾脾门淋巴结清扫术,淋巴结清扫效果与开腹手术相当,但腹腔镜手术利于患者术后恢复,有降低患者远期复发风险可能。

Objective To compare the clinical values of laparoscopic and open surgeryin spleen-sparing lymph node dissection.Methods Data of patients with progressiveupper and middle gastric cancer who underwent total gastrectomy and D2 lymph node dissection in our hospital from May 2017 to December 2017were analyzed retrospectively.Patients received either laparoscopic surgery(group A,n=28)or laparotomy(group B,n=24).Surgical indicators(operation time,intraoperative blood loss,number of lymph nodes removed,number of splenic hilarlymph nodes removed,splenic hilar lymph node dissection time,first out-of-bed time,etc.)and postoperative complications(anastomotic fistula,abdominal infection,intestinal obstruction,pulmonary infection,etc.)were compared between the two groups.In addition,serum CEA and CA-199 levels were measured before and 6 months after surgery.Results Compared with group B,intraoperative blood loss,splenic hilar lymph node dissection timeand first out-of-bed time decreased in group A(P<0.05).There were no significant differences inoperation time,number of lymph nodes removed andnumber of splenic hilar lymph nodes removed between the two groups(P>0.05).No death occurred in both groups.The incidence of postoperative complications in group A(10.71%,3/28)was not significantly different from that in group B(16.67%,4/24)(χ2=0.393,P=0.690).Serum CEA and CA-199 levels determined 6 months after surgerywere lower than those determined before treatmentin both groups,and those in group A were lower than those in group B at 6 months after surgery(P<0.05).Conclusion Laparoscopic spleen-preserving splenic hilar lymph node dissectionis comparable to laparotomy in radical total gastrectomy for progressive upper and middle gastric cancer.However,laparoscopic surgery is beneficial to postoperative recovery and can reduce the long-term risk of recurrence.