腹腔镜胃癌根治术联合托出式脾门入路淋巴结清扫治疗胃癌的效果及远期预后观察

Laparoscopic radical gastrectomy combined with splenic portal lymph node dissection in the treatment of gastric cancer and its long-term prognosis

目的探究腹腔镜胃癌根治术联合托出式脾门入路淋巴结清扫治疗胃癌及远期预后效果。方法回顾性分析2017年9月至2019年12月本院收治的80例胃癌症患者的临床资料,按手术方式不同分为联合组(n=42)与对照组(n=38)。对照组采用常规开腹保脾淋巴结清扫术治疗,联合组采用腹腔镜胃癌根治术联合托出式脾门入路淋巴结清扫治疗,比较两组围手术期情况(术中出血量、手术时间、住院时间),淋巴清扫程度(淋巴结清扫总数目、脾门处淋巴结清扫数目时间及数目),术前及术后1年血清癌胚抗原(CEA)、血清糖抗原19-9(CA19-9)指标;术后2年内并发症发生率及死亡率。结果联合组术中出血量明显少于对照组,住院时间明显短于对照组,手术时间明显长于对照组,差异有统计学意义(P<0.05)。联合组淋巴结清扫总数目、脾门处淋巴结清扫数目明显多于对照组,脾门处淋巴结清扫时间明显长于对照组,差异有统计学意义(P<0.05)。术后1年,两组CEA、CA19-9水平均低于术前,且联合组低于对照组,差异有统计学意义(P<0.05)。术后1年,两组并发症发生率及死亡率比较差异无统计学意义。结论腹腔镜胃癌根治术联合托出式脾门入路淋巴结清扫术围手术期恢复效果显著,淋巴清扫程度与常规开腹手术相当,远期预后效果良好,值得临床推广应用。

Objective To explore the effect of laparoscopic radical gastrectomy combined with splenic portal lymph node dissection in the treatment of gastric cancer and the long-term prognosis.Methods The clinical data of 80 patients with gastric cancer admitted to our hospital from September 2017 to December 2019 were retrospective analyzed,and they were divided into combination group(n=42)and control group(n=38)according to different surgical methods.The control group underwent conventional open spleen-preserving lymph node dissection,and the combination group underwent laparoscopic radical gastrectomy combined with push-out splenic portal lymph node dissection.The perioperative conditions were compared(intraoperative blood loss,surgery time,hospital stay),lymphatic dissection degree(total number of lymph node dissection,time and number of lymph node dissection at spleen hilum),serum carcinoembryonic antigen(CEA),serum carbohydrate antigen 19-9(CA19-9)indicators before and 1 year after surgery,the incidence of complications and mortality within 2 years after operation between the two groups were compared.Results The intraoperative blood loss of the combined group was significantly less than that of the control group,the hospital stay was significantly shorter than that of the control group,and the operation time was significantly longer than that of the control group,the difference was statistically significant(P<0.05).The total number of lymph node dissections and the number of lymph nodes at the splenic hilum in the combined group were significantly more than those in the control group,and the time for lymph nodes at the splenic hilum was significantly longer than that in the control group,and the difference was statistically significant(P<0.05).1 year after operation,the levels of CEA and CA19-9 in the two groups were lower than those before the operation,and the combined group was lower than the control group,the difference was statistically significant(P<0.05).1 year after surgery,there was no significant difference in the incidence of complications and mortality between the two groups.Conclusion The perioperative recovery effect of laparoscopic radical gastrectomy combined with expelling splenic portal lymph node dissection is significant.The degree of lymphatic dissection is equivalent to that of laparotomy,and the long-term prognosis is good.It is worthy of clinical application.