腹腔镜D2根治术联合胃背侧系膜近胃端完整系膜切除术治疗进展期胃癌的近期疗效

Short-term efficacy of laparoscopic-assisted D2 radical gastrectomy combined with complete mesogastric excision for advanced gastric cancer

目的分析腹腔镜D2根治术联合胃背侧系膜近胃端完整系膜切除术(CME)治疗进展期胃癌的近期疗效。方法回顾性分析2018年2月—2019年1月滨州医学院附属医院收治的80例进展期胃癌患者临床资料。将40例实施腹腔镜D2根治术的患者作为对照组,其余40例实施腹腔镜D2根治术联合CME的患者作为观察组。比较两组患者的手术指标、生活质量综合评定问卷(GQOLI-74)、并发症发生率、肿瘤复发率、肿瘤转移率、生存率。结果观察组手术时间、住院时间短于对照组(P<0.05),术中出血量少于对照组,淋巴结清扫数目多于对照组(P<0.05)。两组患者首次排气时间比较,差异无统计学意义(P>0.05)。两组患者并发症发生率比较,差异无统计学意义(P>0.05)。两组患者6个月生存率、肿瘤复发率、肿瘤转移率比较,差异无统计学意义(P>0.05)。观察组1年的生存率高于对照组,肿瘤转移率低于对照组(P<0.05)。两组患者1年的肿瘤复发率比较,差异无统计学意义(P>0.05)。观察组和对照组术后GQOLI-74评分较术前升高(P<0.05)。观察组术后GQOLI-74评分较对照组升高(P<0.05)。两组患者术前GQOLI-74评分比较,差异无统计学意义(P>0.05)。结论CME联合D2根治术治疗进展期胃癌有利于彻底清除淋巴结,减少手术时间及术中出血量,促进术后恢复,改善生活质量,并发症更少,较D2根治术可行性更高。

Objective To analyze the short-term efficacy of laparoscopic-assisted D2 radical surgery combined with complete mesogastric excision(CME)in the treatment of advanced gastric cancer.Methods The clinical data of 80 patients with advanced gastric cancer admitted to our hospital from February 2018 to January 2019 were retrospectively analyzed.According to different surgical methods,40 patients who underwent laparoscopic-assisted D2 radical resection were included in the D2 group,and the rest forty patients who underwent laparoscopic-assisted D2 radical resection plus CME surgery were included in the CME+D2 group.The surgery related indicators,Generic Quality of Life Inventory-74(GQOLI-74)score,complication rate,tumor recurrence rate,metastasis rate,and the survival rate were compared between the groups.Results Compared with D2 group,the operative duration and length of hospital stay were shorter,intraoperative blood loss was less and the number of lymph node dissections was fewer in the CME+D2 group(P<0.05).There was no difference in the time to pass gas after surgery,complication rate,or 6-month survival rate,tumor recurrence rate and metastasis rate between the two groups(P>0.05).The 1-year survival rate was higher but the metastasis rate was lower in the CME+D2 group than in the D2 group(P<0.05).However,1-year tumor recurrence rate was not different between the groups(P>0.05).The post-surgery GQOLI-74 scores in the CME+D2 group were higher than those in D2 group,though they were improved in both groups in relative to GQOLI-74 scores prior to the surgery(P<0.05).Besides,preoperative GQOLI-74 scores did not differ between the two groups(P>0.05).Conclusions Laparoscopic-assisted D2 radical surgery combined with CME is conducive to complete lymph node dissection,reduces operative duration and intraoperative blood loss,promotes postoperative recovery and improves the quality of life for patients with advanced gastric cancer.It has fewer postoperative complications and is more feasible in the treatment of advanced gastric cancer compared with laparoscopic-assisted D2 radical surgery alone.