腹腔镜近端胃大部切除术与远端胃大部切除术治疗胃癌的疗效及安全性分析

Efficacy and safety of laparoscopic proximal subtotal gastrectomy and distal gastrectomy in the treatment of gastric cancer

目的探讨腹腔镜技术在行近端胃大部切除术与远端胃大部切除术中2种手术方式治疗胃癌的疗效及安全性研究。方法回顾性分析淮南东方医院集团总医院普外科2016年1月—2020年1月期间收治的98例胃癌患者的临床资料,其中男性71例,女性27例,年龄32~80岁,平均年龄(62.03±10.6)岁。根据手术方式不同分为近端组(n=28)和远端组(n=70)。近端组采用腹腔镜近端胃大部切除术治疗,远端组采用腹腔镜远端胃大部切除术治疗。采用SPSS 20.0软件分析两组手术相关临床指标、术后并发症、营养状况、生存质量及生存率之间的差异,采用Kaplan-Merier绘制生存曲线,两组生存差异比较采用Log-rank检验。结果近端组淋巴结清扫数目少于远端组,差异有统计学意义(t=2.02,P=0.045);近端组反流性食管炎发病率高于远端组(57.14%比4.29%,χ^(2)=35.75,P<0.001),反流性胃炎发病率则低于远端组,差异有统计学意义(3.57%比22.86%,P=0.035);术后近端组红细胞、血红蛋白及白蛋白水平均低于远端组,差异有统计学意义(t=2.62,P=0.010;t=2.12,P=0.036;t=3.54,P=0.001);术后1个月,近端组Karnofsky功能状态评分低于远端组,差异有统计学意义(t=2.27,P=0.025);近端组术后1、3、5年生存率分别为85.71%、64.29%、46.43%,远端组术后1、3、5年生存率分别为88.57%、71.43%、57.14%,两组生存曲线比较,差异无统计学意义(P>0.05)。结论腹腔镜近端胃大部切除术后并发反流性食管炎发病率高于远端胃大部切除术,且术中清扫淋巴结数目少于远端胃大部切除组,与腹腔镜远端胃大部切除术相比近端胃大部切除术患者术后营养状况明显较差,但两组远期生存率无明显差异。

Objective To explore the efficacy and safety of laparoscopic technology in the treatment of gastric cancer which using proximal subtotal gastrectomy and distal subtotal gastrectomy.Methods A retrospective analysis was conducted on the clinical data of 98 gastric cancer patients admitted to the Department of General Surgery,General Hospital of Huainan Eastern Hospital Group from January 2016 to January 2020,including 71 males and 27 females with an average age of(62.03±10.6)years old(ranged from 32 to 80 years).All cases were divided into proximal group(n=28)and distal group(n=70)according to different surgical methods.The proximal group was treated with laparoscopic proximal subtotal gastrectomy,while the distal group was treated with laparoscopic distal subtotal gastrectomy.SPSS 20.0 software was used to analyze the differences in surgical related clinical indicators,postoperative complications,nutritional status,quality of life,and survival rate between two groups.Kaplan-Merier was used to draw survival curves,and Log-rank test was used to compare the survival differences between the two groups.Results The number of lymph node dissection in the proximal group was less than that in the distal group,and the difference was statistically significant(t=2.02,P=0.045).The incidence rate of reflux esophagitis in the proximal group was higher than that in the distal group(57.14%vs 4.29%,χ^(2)=35.75,P<0.001),the incidence rate of reflux gastritis was lower than that of the distal group,the difference was statistically significant(3.57%vs 22.86%P=0.035).The levels of red blood cells,hemoglobin,and albumin in the proximal group were lower than those in the distal group after surgery,and the differences were statistically significant(t=2.62,P=0.010;t=2.12,P=0.036;t=3.54,P=0.001).One month after surgery,the Karnofsky functional status score in the proximal group was lower than that in the distal group,and the difference was statistically significant(t=2.27,P=0.025).The postoperative 1,3,and 5-year survival rates of the proximal group were 85.71%,64.29%,and 46.43%,respectively,while the postoperative 1,3,and 5-year survival rates of the distal group were 88.57%,71.43%,and 57.14%,respectively.There was no statistically significant difference in the survival curves between the two groups(P>0.05).Conclusions The incidence rate of reflux esophagitis after laparoscopic proximal subtotal gastrectomy is higher than that of distal subtotal gastrectomy,and the number of lymph nodes cleared during operation is less than that of distal subtotal gastrectomy.Compared with laparoscopic distal subtotal gastrectomy,the nutritional status of patients after proximal subtotal gastrectomy is significantly worse,but there is no significant difference in long-term survival rate between the two groups.