PSDM模型下胃癌完整系膜切除术治疗进展期胃癌的临床研究

Clinical Study of Complete Mesogastric Excision Plus D2 Lymphadenectomy(CME+D2)for Advanced Gastric Cancer in the PSDM

目的:探讨胃背侧系膜近侧段(PSDM)模型下胃癌完整系膜切除术(CME+D2)治疗进展期胃癌的临床疗效。方法:选取80例进展期胃癌患者为研究对象,根据所采取术式分为观察组(CME+D2组)和对照组(标准D2根治术组),每组各40例;比较2组手术时间、术中出血量、淋巴结清扫个数、术后首次排气时间、术后首次排便时间、7 d内腹腔引流管拔除比率、术后住院时间、术后7 d内并发症发生率、1年内癌肿瘤复发率。结果:观察组手术时间短于对照组(P<0.05),术中出血量[55(50.0~60.0)mL]少于对照组[90(65.0~117.5)mL](P<0.05),淋巴结清扫个数[28(24.3~39.0)个]多于对照组[26(22.0~30.0)个](P<0.05);观察组术后首次排气时间、术后首次排便时间及术后住院时间均优于对照组,术后7 d内并发症发生率(22.50%)低于对照组(45.00%);2组术后7 d内腹腔引流管拔除率及1年内肿瘤复发率比较差异无统计学意义(P>0.05)。结论:PSDM模型下胃癌完整系膜切除术(CME+D2)相对于标准D2根治术,手术时间更短,术中出血量更少,淋巴结清扫更彻底,术后胃肠道功能恢复更快、并发症更少。

Objective:To investigate the clinical efficacy of complete mesogastric excision plus D2 lymphadenectomy(CME+D2)for advanced gastric cancer in the PSDM model.Methods:A total of 80 patients with advanced gastric cancer were selected as research objects and divided into the study group(CME+D2 group)and the control group(standard D2 radical gastrectomy group)according to the operation methods adopted,with 40 cases in each group.The operation time,the intraoperative blood loss,the number of lymph node dissections,the time of first postoperative gas evacuation,the time of first postoperative defecation,rate of abdominal drain removal within 7 d,the postoperative hospitalization stay rate of complication within 7 d postoperatively,and rate of cancer-tumor recurrence within 1 year were compared between the two groups.Results:Compared with the control group(standard D2 radical gastrectomy group),the study group(CME+D2 group)had the shorter time of operation(P<0.05),less intraoperative blood loss(P<0.05)and more lymph node dissected(P<0.05),earlier time of first postoperative gas evacuation and first postoperative defecation(P<0.05),the shorter postoperative hospitalization stay(P<0.05),and lower incidence of complications within 7 days after surgery(P<0.05);In both groups,the removal rate of abdominal drain within 7 days after surgery(P>0.05),and the recurrence rate of tumor within 1 year(P>0.05)had no statistical significance.Conclusion:Compared with standard D2 radical gastrectomy,complete mesocolic excision(CME+D2)for gastric cancer in the PSDM model has the shorter time of operation less intraoperative bleeding,more thorough lymph node dissection,faster recovery of gastrointestinal function,and fewer complications,which is worthy of clinical promotion.