腹腔镜辅助下近端胃切除术与腹腔镜辅助下全胃切除术加食道空肠Roux-en-Y吻合术治疗近端胃癌的效果比较

Comparison on the effect of laparoscopy-assisted proximal gastrectomy and laparoscopy-assisted total gastrectomy with esophageal jejunum Roux-en-Y anastomosis in the treatment of proximal gastric cancer

目的探讨腹腔镜辅助下近端胃切除术(LAPG)和腹腔镜辅助下全胃切除术加食道空肠Roux-en-Y吻合术(LATG-RY)治疗近端胃癌患者的临床疗效。方法回顾性分析2018年12月至2020年12月于上饶东信第五医院确诊的78例近端胃癌患者的临床资料,根据手术方式不同分为观察组(n=43)与对照组(n=35)。对照组采用LAPG治疗,观察组采用LATG-RY治疗,比较两组围手术期指标、肿瘤指标(淋巴结清扫数目、远近端切缘距离)、术后并发症发生情况、临床疗效及复发率。结果观察组手术出血量多于对照组,手术时间长于对照组,差异有统计学意义(P<0.05);两组手术切口长度、首次通气时间、首次进食时间、住院时间及治疗费用比较差异无统计学意义。观察组近端切缘、远端切缘均长于对照组,淋巴结清扫数目多于对照组,差异有统计学意义(P<0.05)。观察组术后并发症发生率为13.95%,低于对照组40.00%,差异有统计学意义(P<0.05)。观察组治疗总有效率为95.35%,高于对照组77.14%,差异有统计学意义(P<0.05)。观察组复发率为2.33%,低于对照组的20.00%,差异有统计学意义(P<0.05)。结论LATG-RY和LAPG治疗近端胃癌均具有一定安全性、有效性,LATG-RY术后并发症少、临床疗效显著、复发率低;LAPG手术出血量少,手术时间、近端切缘、远端切缘均较短,淋巴结清扫数目少,临床可结合患者病情及其自身意见选择最适合的术式。

Objective To explore the clinical effect of laparoscopy-assisted proximal gastrectomy(LAPG)and laparoscopy-assisted total gastrec-tomy with esophageal jejunum Roux-en-Y anastomosis(LATG-RY)in treatment of patients with proximal gastric cancer.Methods The clinical data of 78 patients with proximal gastric cancer confirmed in Shangrao Dongxin Fifth Hospital from December 2018 to December 2020 were retrospective-ly analyzed,and they were divided into the observation group(n=43)and the control group(n=35)according to different surgical methods.The con-trol group was treated with LAPG,and the observation group was treated with LATG-RY,the perioperative indexes,tumor indexes(number of lymph nodes dissection,distance of distal and proximal resection margin),occurrence of postoperative complications clinical efficacy and recurrence rate were compared between the two groups.Results The intraoperative blood loss in the observation group was more than that in the control group,and the operation time was longer than that in the control group,the differences were statistically significant(P<0.05).There was no significant difference in incision length,the first ventilation time,first eating time,hospitalization time and treatment cost between the two groups.The proximal resection margin and distal resection margin in the observation group were longer than those in the control group,and number of lymph node dissection was more than that in the control group,the differences were statistically significant(P<0.05).The incidence of postoperative complications in the obser-vation group was 13.95%,which was lower than 40.00%in control group,and the difference was statistically significant(P<0.05).The total effective rate in the observation group was 95.35%,which was higher than 77.14%in the control group,and the difference was statistically significant(P<0.05).The recurrence rate in the observation group was 2.33%,which was lower than 20.00%in the control group,and the difference was statistically significant(P<0.05).Conclusion LATG-RY and LAPG have certain safety and effectiveness in the treatment of proximal gastric cancer,LATG-RY has fewer postoperative complications,significant clinical efficacy and low recurrence rate;LAPG has less bleeding,shorter operation time,proximal margin and distal margin,and less number of lymph node dissection,the most suitable operation method can be selected according to the patient's con-dition and his own opinion.