腹腔镜微创手术治疗局部进展期食管胃交界部腺癌术中腹腔冲洗灭菌注射用水用量对疗效的影响

Evaluation of the effect of amounts of sterile water for injection for celiac irrigation in laparoscopic treatment of local advanced adenocarcinoma of esophagogastric junction

目的:探讨术中灭菌注射用水在腹腔冲洗中的用量对腹腔镜微创手术治疗局部进展期食管胃交界部腺癌(AEG)患者疗效的影响。方法:选取2013年10月至2014年12月行腹腔镜手术治疗的进展期AEG患者120例,按照灭菌注射用水在腹腔冲洗中的用量分为4组,每组30例。A组:1 000 mL;B组:3 000 mL;C组:5 000 mL;D组:10 000 mL。比较4组患者的手术并发症及不良反应发生率、术后局部复发率、转移率及无进展生存率。结果:4组患者手术并发症的发生率、不良反应发生率未见明显差异(P>0.05)。4组患者的肝转移率、1年无进展生存率未见明显差异(P>0.05),A、B组的局部复发率、转移率和无进展生存率无明显差异(P>0.05),C、D组的局部复发率、转移率和无进展生存率无明显差异(P>0.05)。但是C、D组的局部复发率和腹腔转移率均低于A、B组,3年及5年无进展生存率均高于A、B组(P<0.05)。按照肿瘤浸润深度、有无淋巴结转移分层情况,可见在T_2期和无淋巴结转移的患者中,4组的局部复发率、转移率、无进展生存率未见明显差异(P>0.05);而在肿瘤浸润较深的T_3或T_(4a)期以及有淋巴结转移的患者中,虽然4组患者的肝转移率、1年无进展生存率未见明显差异(P>0.05),但是C、D组的局部复发率和腹腔转移率均低于A、B组,3年及5年无进展生存率均高于A、B组(P<0.05),而且D组的腹腔转移率还低于C组(P<0.05),3年及5年无进展生存率还高于C组(P<0.05)。结论:随着冲洗腹腔的灭菌注射用水的用量增加,能够有效降低患者的局部复发率和腹腔转移率,提高患者的无进展生存率,延长患者的无进展生存期,但是无法降低肝转移发生率,对肿瘤浸润较深、有淋巴结转移的患者,应提倡此手术操作。

Objective:To evaluate the effect of the amount of sterile water for injection for celiac irrigation in laparoscopic treatment of local advanced adenocarcinoma of esophagogastric junction(AEG).Methods:120 patients with advanced AEG who had celiac irrigation underwent laparoscopic surgery from October 2013 to December 2014 were selected and divided into 4 groups according to the amount of sterile water for injection,with 30 patients in each group,including group A with 1000 mL,group B with 3000 mL,group C with 5000 mL,group D with 10000 mL.The incidence of surgical complications and adverse reactions,postoperative local recurrence rate,metastasis rate and progression-free survival rate of the 4 groups were compared.Results:There was no significant difference in the incidence of surgical complications and adverse reactions among the 4 groups(P>0.05).There was no significant difference in liver metastasis rate and 1-year progression-free survival rate among the 4 groups(P>0.05),while there was no significant difference in local recurrence rate,metastasis rate and progression-free survival rate between the A and B groups(P>0.05),and there was also no significant difference in local recurrence rate,metastasis rate and progression-free survival rate between groups C and D(P>0.05).However,the local recurrence rate and peritoneal metastasis rate in C and D groups were lower than those in A and B groups,and the 3-year and 5-year progression-free survival rates were higher than those in A and B groups(P<0.05).According to the depth of tumor invasion and stratification of lymph node metastasis,there was no significant difference in local recurrence rate,metastasis rate and progression-free survival rate amang 4 groups in T 2 stage and those without lymph node metastasis(P>0.05).There was no significant difference in liver metastasis rate and 1-year progression-free survival amang 4 groups in T 3 or T 4a stage and those with lymph node metastasis(P>0.05).In the deeper tumor invasion with T 3 or T 4a stage,and in patients with lymph node metastasis,but local recurrence rate and celiac metastasis rate in C and D groups were lower than group A and B(P<0.05),3-year and 5-year progression-free survival rates were higher than in A and B group(P<0.05),and also peritoneal metastasis rate of group D was lower than that of group C(P<0.05),3-year and 5-year progression-free survival rates were higher than that of group C(P<0.05).Conclusion:We can effectively reduce local recurrence rate and celiac metastasis rate,improve progression-free survival,associated with the increase of the amount of sterile water for injection for celiac irrigation in laparoscopic treatment of patients with local advanced AEG.But it was useless to reduce liver metastasis rate.We should especially advocate using large amount of sterile water for injection to irrigate abdominal cavity during laparoscopic operation on AEG patients with deeper tumor invasion and lymph node metastasis.