D2胃切除术中行No.14v淋巴结清扫对局部进展期远端胃癌患者预后的影响

Effects of No.14v Lymph Node Dissection During D2 Gastrectomy on the Prognosis of Patients with Locally Advanced Distal Gastric Cancer

目的:探讨D2胃切除术中行No.14v淋巴结清扫对局部进展期远端胃癌患者预后的影响。方法:选取50例局部进展期远端胃癌患者为受试对象,按照随机数表法分为研究组与对照组,各25例。对照组采用D2胃切除术,研究组在对照组基础上行No.14v淋巴结清扫。比较两组患者手术相关指标(手术时间、术中出血量、平均淋巴结清扫数量)评估差异;比较术前及术后3年时,两组患者血清肿瘤标志物[癌胚抗原(CEA)、糖类抗原(CA)199、CA724]水平变化;比较术后1个月内,两组患者并发症发生情况差异;比较术后1年时及术后3年时,两组患者生存率(总生存率、无进展生存率)及淋巴结转移率情况变化。结果:两组患者手术时间、术中出血量比较无统计学意义(P>0.05),研究组患者平均淋巴结清扫数量明显多于对照组(P<0.05);术后3年时,两组患者CEA、CA199、CA724水平均较术前显著降低(P<0.05),且研究组明显低于同一时间对照组(P<0.05);术后1个月内,两组患者肺部感染、胸腔积液、吻合口瘘、肠梗阻发生率比较无统计学意义(P>0.05);术后3年时,研究组患者总生存率、无进展生存率均明显高于同一时间对照组(P<0.05),且淋巴结转移率均明显低于同一时间对照组(P<0.05)。结论:D2胃切除术中行No.14v淋巴结清扫应用于局部进展期远端胃癌患者,可增加淋巴结清扫数量,改善血清肿瘤标志物水平,提高患者术后生存率,降低淋巴结转移率。

Objective:To investigate the effects of No.14v lymph node dissection during D2 gastrectomy on the prognosis of patients with locally advanced distal gastric cancer.Methods:50 patients with locally advanced distal gastric cancer were selected as study subjects,and they were divided into study group and control group according to the random number table method,with 25 cases in each group.Control group was given D2 gastrectomy while study group was given No.14v lymph node dissection on the basis of control group.The surgical related indicators(surgical time,intraoperative blood loss,average quantity of lymph node dissections)were compared between the two groups.The serum tumor markers[carcinoembryonic antigen(CEA),carbohydrate antigen(CA)199,CA724]were compared between the two groups before surgery and at 3 years after surgery.The occurrence of complications were compared between the two groups within 1 month after surgery.The survival rates(total survival rate,progression-free survival rate)and lymph node metastasis rate were compared between the two groups at 1 year and 3 years after surgery.Results:There were no significant differences in the surgical time and intraoperative blood loss between the two groups(P>0.05).The average quantity of lymph node dissections in study group was significantly higher than that in control group(P<0.05).At 3 years after surgery,the levels of CEA,CA199 and CA724 in the two groups were significantly decreased compared with those before surgery(P<0.05),and the levels in study group were significantly lower than those in control group at the same time point(P<0.05).Within 1 month after surgery,there were no statistically significant differences in the incidence rates of lung infection,pleural effusion,anastomotic fistula and intestinal obstruction between the two groups(P>0.05).At 3 years after surgery,the overall survival rate and progression-free survival rate in study group were significantly higher than those in control group at the same time point(P<0.05),and the lymph node metastasis rate was significantly lower than that in control group at the same time point(P<0.05).Conclusion:No.14v lymph node dissection during D2 gastrectomy for patients with locally advanced distal gastric cancer can increase the quantity of lymph node dissections,improve serum tumor markers levels,enhance postoperative survival rate,and reduce lymph node metastasis rate.