腹腔镜下保留幽门胃切除术与远端胃切除术治疗早期胃癌的疗效观察

Efficacy of laparoscopic pylorus preserving gastrectomy and distal gastrectomy for the treatment of early stage gastric cancer

目的 探讨腹腔镜下保留幽门胃切除术与远端胃切除术治疗早期胃癌的临床疗效。方法 前瞻性选取2018年7月至2020年12月间武警河南总队医院收治的72例早期胃癌患者,采用随机数字表法分为观察组和对照组,每组36例。对照组患者采用远端胃切除术治疗,观察组患者采用腹腔镜下保留幽门胃切除术治疗,比较两组患者的治疗效果、生存率及生存时间。结果 两组患者淋巴结清扫数目和术中出血量比较,差异无统计学意义;观察组患者术后排气时间和首次排便时间均短于对照组,术中耗时长于对照组,差异均有统计学意义(均P<0.05)。术后,观察组患者各时间段消化病生存质量指数评分均高于对照组,患者主观整体评估评分均低于对照组,差异均有统计学意义(均P<0.05)。术后1个月,观察组患者的白介素-6、肿瘤坏死因子-α和C反应蛋白水平均低于对照组,白蛋白和总蛋白均高于对照组,差异均有统计学意义(均P<0.05)。观察组患者1年后生存35例(97.2%),中位生存时间11个月;对照组患者生存30例(83.3%),中位生存时间10个月,两组比较,差异有统计学意义(P<0.05)。观察组患者并发症发生率为5.6%(2例),对照组为30.6%(11例),两组比较,差异有统计学意义(P<0.05)。结论 早期胃癌患者采用腹腔镜下保留幽门胃切除术治疗,能更好促使胃肠道功能恢复,提高手术安全性。

Objective To explore the clinical efficacy of laparoscopic pylorus preserving gastrectomy and distal gastrectomy for the treatment of early stage gastric cancer. Methods Seven-two patients with early gastric cancer were prospectively sleeted at Armed Police Henan Corps Hospital from July 2018 to December 2020. They were randomly divided into an observation group and a control group with 36 patients in each group. The observation group underwent laparoscopic pylorus preserving gastrectomy and the control group underwent distal gastrectomy. Therapeutic efficacy, survival rate and survival period were compared between the two groups. Results There was no significant difference in number of resected lymph nodes and intraoperative blood loss between the two groups(P>0.05). Time to postoperative exhaust and postoperative defecation were shorter in the observation group than in the control group, and the duration of operation was longer in the observation group than in the control group(all P<0.05). Quality of life scores for patients with digestive disorders were higher in observation group than in the control group at different time points(all P<0.05). The patient’s or subjective global assessment scale score was lower in the observation group than in the control group(P<0.05). At 1 month after operation, interleukin-6, TNF-α, and C reactive protein levels were lower and albumin and total protein levels were higher in the observation group than in the control group(all P<0.05). At 1 year after the operation, 30 patients(97.2%) survived in the observation group with a median survival of 11 months and 30 patients(83.3%) survived in the control group with a median survival of 10 months(P<0.05). The incidence of complications was 5.6%(2 cases) in the observation group and 30.6%(11 cases) in the control group(P<0.05). Conclusion Laparoscopic pylorus preserving gastrectomy can better promote the recovery of gastrointestinal function and improve the safety of operation in patients with early stage gastric cancer.