中间入路近端残胃癌切除术治疗Ⅲc期近端残胃癌的效果

Effect of Resection of Proximal Remnant Gastric Cancer Through Intermediate Approach on StageⅢc Proximal Remnant Gastric Cancer

目的探讨中间入路近端残胃癌切除术治疗Ⅲc期近端残胃癌的效果。方法选取2017年1月至2020年1月信阳市肿瘤医院收治的94例Ⅲc期近端残胃癌患者,将其中47例接受常规入路近端残胃癌切除术治疗的患者纳入常规入路组,47例接受中间入路近端残胃癌切除术治疗的患者纳入中间入路组。比较两组手术指标、手术感染率、根治性切除率及癌胚抗原信使核糖核酸(CEA-mRNA)阳性率。结果与常规入路组比较,中间入路组术中出血量较少(P<0.05),下床时间、进食时间较早(P<0.05)。淋巴结清扫后中间入路组门静脉血CEA-mRNA阳性率低于常规入路组(4.26%比23.40%,P<0.05)。术后3个月中间入路组手术感染率低于常规入路组(4.44%比19.57%,P<0.05),根治性切除率高于常规入路组(100.00%比76.09%,P<0.05)。结论中间入路近端残胃癌切除术治疗Ⅲc期近端残胃癌,可进一步减轻手术创伤,减少术后感染的发生,提高根治性切除率,促进术后恢复,降低术后远处转移风险。

Objective To investigate the effect of proximal remnant gastric cancer resection through the intermediate approach for stageⅢc proximal remnant gastric cancer.Methods A total of 94 patients with stageⅢc proximal remnant gastric cancer admitted to Xinyang Cancer Hospital from January 2017 to January 2020 were collected.Among them,47 patients who underwent conventional proximal resection of gastric remnant gastric cancer were included in conventional approach group,and 47 patients who received proximal remnant gastric cancer resection through the intermediate approach were included in intermediate approach group.The surgical indicators,surgical infection rate,radical resection rate and carcinoembryonic antigen messenger ribonucleic acid(CEA-mRNA)positive rate were compared between the two groups.Results Compared with conventional approach group,the intraoperative blood loss in intermediate approach group was less(P<0.05),and the time to get out of bed and eating was earlier(P<0.05).After lymph node dissection,the positive rate of CEA-mRNA in portal vein blood in intermediate approach group was lower than that in conventional approach group(4.26%vs.23.40%,P<0.05).The surgical infection rate in intermediate approach group was lower than that in conventional approach group(4.44%vs.19.57%,P<0.05).The radical resection rate in intermediate approach group was higher than that in conventional approach group(100.00%vs.76.09%,P<0.05).Conclusion For stageⅢc proximal remnant gastric cancer,resection of proximal remnant gastric cancer through the intermediate approach could further reduce surgical trauma,reduce the incidence of postoperative infection,increase the rate of radical resection,promote postoperative recovery,and reduce the risk of distant metastasis after surgery.