腹腔镜下不同入路行胰腺上方胃系膜切除术治疗胃癌的临床对比

Clinical Comparison of Laparoscopic Suprapancreatic Mesogastrectomywith Different Approaches for the Treatment of Gastric Cancer

目的对比腹腔镜下左侧入路和右侧入路实施胰腺上方胃系膜切除术治疗胃癌的效果。方法本研究为前瞻性随机对照研究,纳入2021年10月至2022年10月在南阳市第二人民医院接受胰腺上方胃系膜切除术治疗的100例胃癌患者作为研究对象,据随机数字表法将100例患者分为两组,各50例,两组患者分别接受不同入路腔镜下胰腺上方胃系膜切除术治疗,将经左侧入路手术患者纳入经左侧组,经右侧入路手术患者纳入经右侧组。记录两组患者手术相关情况;于手术次日和手术7 d分别采用数字分级量表(NRS)、匹兹堡睡眠质量量表评价患者疼痛情况与睡眠质量;记录术后病理情况及并发症发生情况。结果两组患者均顺利完成研究,无退出病例。经右侧组手术时间比经左侧组短,术中出血量比经左侧组少(P<0.05);两组术后肛门排气、下床活动和住院时间比较,差异无统计学意义(P>0.05);术后次日两组NRS评分和术后7 d后睡眠质量评分比较,差异无统计学意义(P>0.05),经右侧组淋巴结清扫数量比经左侧组多,肿瘤远端切缘距离比经左侧组近(P<0.05)。结论腹腔镜下经右侧入路与经左侧入路开展胰腺上方胃系膜切除术治疗胃癌的效果基本一致,但经右侧入路切除在一定程度上可减少患者术中出血量,缩短手术时间,肿瘤远端切缘距离近,且淋巴结清扫数更多。

Objective To compare the effectiveness of laparoscopic left and right approaches for the treatment of gastric cancer by performing suprapancreatic mesogastrectomy.Methods This study was a prospective randomized controlled study that included 100 gastric cancer patients who underwent suprapancreatic mesogastrectomy in Nanyang Second General Hospital from October 2021 to October 2022 as the study subjects.According to the random number table method,100 patients were divided into two groups,with 50 patients in each group.Two groups of patients underwent laparoscopic suprapancreatic mesogastrectomy through different approaches.Patients who underwent surgery through the left approach were included in the left group,while patients who underwent surgery through the right approach were included in the right group.The surgical related information of two groups of patients was recorded.On the day after the surgery and 7 days after the surgery,the pain status and sleep quality of the patients were evaluated using the numerical rating scale(NRS)and the Pittsburgh sleep quality scale,respectively.The postoperative pathological conditions and complications were recorded.Results Both groups of patients successfully completed the study without any withdrawal cases.The surgical time in the right group was shorter than that in the left group,and the intraoperative bleeding was less than that in the left group(P<0.05).There were no differences between the two groups in terms of postoperative anal discharge time,bedtime activity time,and hospitalization time(P>0.05).There were no differences in the NRS score and sleep quality score between the two group on the next day after surgery and the observation group 7 days after surgery(P>0.05).Patients in the right group had more lymph node dissection than those in the left group,and the distance between the distal tumor margin was closer that in the left group(P<0.05).Conclusion The effectiveness of laparoscopic suprapancreatic mesogastrectomy through the right and left approaches for the treatment of gastric cancer is basically the same.However,resection through the right approach can reduce intraoperative bleeding,shorten surgical time,have a closer distance to the distal tumor margin,and have more lymph node dissection.