腹腔镜与传统开腹术联合淋巴结清扫治疗进展期老年胃癌的疗效、预后及安全性评估
|
摘要
目的探讨腹腔镜与传统开腹术联合淋巴结清扫对进展期老年胃癌患者的根治疗效、预后及安全性。方法本研究共招募80例进展期老年胃癌患者,其中腹腔镜组施行腹腔镜下胃癌D2淋巴结清扫术,传统开腹组进行开腹胃癌D2淋巴结清扫术进行治疗。观察2组患者围术期指标,以及第10组和11组淋巴结清扫时间、检出数、阳性数、阳性率及转移率等。治疗后3年内定期随访,记录患者生存情况及生活状态。对相关数据进行统计学分析。结果腹腔镜组的手术时间显著长于开腹组,第10、11组淋巴结的清扫时间也显著高于开腹组(P <0. 05)。开腹组的术中出血量、术后首次排气时间、肠胃功能恢复时间及住院时间均显著高于腹腔镜组(P <0. 05)。此外,开腹组患者术后并发症(17. 5%)显著高于腹腔镜组(7. 5%)(P <0. 05)。术后7天,腹腔镜组患者的生活质量优于开腹组(P <0. 05)。2种手术方式的总体淋巴结检出数,第10、11组淋巴结检出数,第10、11组淋巴结阳性率及第10、11组淋巴结转移率无显著性差异(P> 0. 05)。2组患者3年生存率无统计学差异(P> 0. 05)。结论腹腔镜下全胃切除D2淋巴结清扫对老年进展期胃癌患者的预后及安全性方面均有优势。
Objective To investigate the eradication effect,prognosis and security of two different surgical methods including laparoscopic surgery and conventional open surgery combined with lymph node dissection in the treatment of patients with advanced gastric cancer. Methods In this study,a total of 80 patients with advanced gastric cancer were enrolled. Laparoscopic D2 lymph node dissection was performed in laparoscopic surgery group and D2 lymph node dissection during the laparotomy was performed in conventional open surgery group. The perioperative indexes of the two groups were observed,as well as the time of lymph node dissection,the number of detection,the positive number,the positive rate and the metastasis rate in groups 10 and 11 lymph nodes. Patients were followed up for three years after treatment and the patient's survival and living conditions were recorded. The relevant data were analyzed by statistical method. Results In our study,we found that the operation time of laparoscopic surgery group was significantly higher than that of conventional open surgery group. The clearance time of groups 10 and 11 lymph nodes was also significantly higher than that of conventional open surgery group( P < 0. 05). Compared with laparoscopic surgery group,the intraoperative blood loss,the first postoperative exhaust time,the recovery time of gastrointestinal function and hospital stay were significantly higher( P < 0. 05). In addition,postoperative complications( 17. 5%) in the conventional open surgery group was significantly higher than those in the laparoscopic surgery group( 7. 5%)( P < 0. 05). After 7 days,the quality of life of patients in laparoscopic surgery group was better than that of conventional open surgery group( P < 0. 05). There was no significant difference in total number of lymph nodes,the number of groups 10 and 11 lymph nodes,the positive rate and the metastasis rate of groups 10 and 11 lymph nodes( P > 0. 05). Moreover,there was no significant difference in 3-year survival rate between the two groups( P > 0. 05). Conclusion Laparoscopic gastrectomy surgery combined with lymph node dissection has advantages in the prognosis and security of elderly patients with advanced gastric cancer.
Objective To investigate the eradication effect,prognosis and security of two different surgical methods including laparoscopic surgery and conventional open surgery combined with lymph node dissection in the treatment of patients with advanced gastric cancer. Methods In this study,a total of 80 patients with advanced gastric cancer were enrolled. Laparoscopic D2 lymph node dissection was performed in laparoscopic surgery group and D2 lymph node dissection during the laparotomy was performed in conventional open surgery group. The perioperative indexes of the two groups were observed,as well as the time of lymph node dissection,the number of detection,the positive number,the positive rate and the metastasis rate in groups 10 and 11 lymph nodes. Patients were followed up for three years after treatment and the patient's survival and living conditions were recorded. The relevant data were analyzed by statistical method. Results In our study,we found that the operation time of laparoscopic surgery group was significantly higher than that of conventional open surgery group. The clearance time of groups 10 and 11 lymph nodes was also significantly higher than that of conventional open surgery group( P < 0. 05). Compared with laparoscopic surgery group,the intraoperative blood loss,the first postoperative exhaust time,the recovery time of gastrointestinal function and hospital stay were significantly higher( P < 0. 05). In addition,postoperative complications( 17. 5%) in the conventional open surgery group was significantly higher than those in the laparoscopic surgery group( 7. 5%)( P < 0. 05). After 7 days,the quality of life of patients in laparoscopic surgery group was better than that of conventional open surgery group( P < 0. 05). There was no significant difference in total number of lymph nodes,the number of groups 10 and 11 lymph nodes,the positive rate and the metastasis rate of groups 10 and 11 lymph nodes( P > 0. 05). Moreover,there was no significant difference in 3-year survival rate between the two groups( P > 0. 05). Conclusion Laparoscopic gastrectomy surgery combined with lymph node dissection has advantages in the prognosis and security of elderly patients with advanced gastric cancer.
引文
[1]王璋,吴泉峰.腹腔镜与开放式修补术治疗老年胃溃疡穿孔的临床疗效的比较[J].中南医学科学杂志,2016,44(1):93-95.
[2]Japanese Gastric Cancer Association.Japanese gastric cancer treatment guidelines 2010(ver.3)[J].Gastric Cancer Official Journal of the International Gastric Cancer Association&the Japanese Gastric Cancer Association,2011,14(2):113.
[3]胡祥.胃切除术后消化道重建方式的选择[J].中华消化外科杂志,2015,14(11):898-901.
[4]王高翔,毛兴江.腹腔镜手术和开放D2根治术治疗胃癌的围术期情况和远期疗效分析[J].实用癌症杂志,2017,32(6):986-988.
[5]杨洁,李龙,张耕源,等.弥漫型进展期胃癌的预后及手术方式的临床研究[J].中南大学学报(医学版),2016,41(2):151-157.
[6]黄昌明,陆俊.局部进展期胃上部癌腹腔镜淋巴结清扫的评价与策略[J].第三军医大学学报,2013,35(18):1896-1899.
[7]Bara S,Law C,Meleod R,et al.Defining surgical quality in gastric cancer:a RAND/UCLA appropriateness study[J].JACS,2013,217(2):347-357.
[8]张春侠,王妍,章来长,等.全胃切除联合脾切除对进展期胃癌预后的影响[J].中国现代普通外科进展,2015,17(9):697-699.
[9]Zhang H,Pang DY,Xu HM,et al.Is concomitant splenectomy beneficial for long-term survival of patients with gastric cancer undergoing curative gastrectomy A single-institute study[J].World J Surg Oncol,2014,12(1):193-196.
[10]何锐,李玉红,丁倩男,等.乳酸林格氏液体和羟乙基淀粉130/0.4氯化钠注射液对腹腔镜下胃肠癌根治术术后结局的影响[J].中国现代应用药学,2016,33(4):466-473.
[11]赵立志.腹腔镜与内镜联合手术治疗胃肠道肿瘤效果分析[J].检验医学与临床,2016,13(A02):340-341.
[12]梁節.腹腔镜下胃癌手术后血液高凝状态发生的监测及护理[J].血栓与止血学,2017,23(2):333-335.
[13]林琳,许庆文,徐飞鹏,等.腹腔镜与开腹根治性全胃切除术并D2淋巴清扫治疗中上部进展期胃癌安全性的研究[J].中华实验外科杂志,2016,33(11):2566-2568.
[14]杜大军.腹腔镜辅助D2根治术对远端进展期胃癌患者肿瘤及复发转移相关指标的影响研究[J].实用癌症杂志,2017,32(5):713-715.
[15]何磊,文刚,涂从银,等.保留脾脏的第10组与11组淋巴结整体清扫在胃癌D2根治术中的应用价值[J].中华消化外科杂志,2016,15(11):1113-1117.
[16]彭朝阳,丁恒一,司建伟.腹腔镜和开腹原发灶切除联合D2淋巴结清扫术治疗老年进展期胃癌临床对比研究[J].中国普外基础与临床杂志,2017,24(7):848-853.
[2]Japanese Gastric Cancer Association.Japanese gastric cancer treatment guidelines 2010(ver.3)[J].Gastric Cancer Official Journal of the International Gastric Cancer Association&the Japanese Gastric Cancer Association,2011,14(2):113.
[3]胡祥.胃切除术后消化道重建方式的选择[J].中华消化外科杂志,2015,14(11):898-901.
[4]王高翔,毛兴江.腹腔镜手术和开放D2根治术治疗胃癌的围术期情况和远期疗效分析[J].实用癌症杂志,2017,32(6):986-988.
[5]杨洁,李龙,张耕源,等.弥漫型进展期胃癌的预后及手术方式的临床研究[J].中南大学学报(医学版),2016,41(2):151-157.
[6]黄昌明,陆俊.局部进展期胃上部癌腹腔镜淋巴结清扫的评价与策略[J].第三军医大学学报,2013,35(18):1896-1899.
[7]Bara S,Law C,Meleod R,et al.Defining surgical quality in gastric cancer:a RAND/UCLA appropriateness study[J].JACS,2013,217(2):347-357.
[8]张春侠,王妍,章来长,等.全胃切除联合脾切除对进展期胃癌预后的影响[J].中国现代普通外科进展,2015,17(9):697-699.
[9]Zhang H,Pang DY,Xu HM,et al.Is concomitant splenectomy beneficial for long-term survival of patients with gastric cancer undergoing curative gastrectomy A single-institute study[J].World J Surg Oncol,2014,12(1):193-196.
[10]何锐,李玉红,丁倩男,等.乳酸林格氏液体和羟乙基淀粉130/0.4氯化钠注射液对腹腔镜下胃肠癌根治术术后结局的影响[J].中国现代应用药学,2016,33(4):466-473.
[11]赵立志.腹腔镜与内镜联合手术治疗胃肠道肿瘤效果分析[J].检验医学与临床,2016,13(A02):340-341.
[12]梁節.腹腔镜下胃癌手术后血液高凝状态发生的监测及护理[J].血栓与止血学,2017,23(2):333-335.
[13]林琳,许庆文,徐飞鹏,等.腹腔镜与开腹根治性全胃切除术并D2淋巴清扫治疗中上部进展期胃癌安全性的研究[J].中华实验外科杂志,2016,33(11):2566-2568.
[14]杜大军.腹腔镜辅助D2根治术对远端进展期胃癌患者肿瘤及复发转移相关指标的影响研究[J].实用癌症杂志,2017,32(5):713-715.
[15]何磊,文刚,涂从银,等.保留脾脏的第10组与11组淋巴结整体清扫在胃癌D2根治术中的应用价值[J].中华消化外科杂志,2016,15(11):1113-1117.
[16]彭朝阳,丁恒一,司建伟.腹腔镜和开腹原发灶切除联合D2淋巴结清扫术治疗老年进展期胃癌临床对比研究[J].中国普外基础与临床杂志,2017,24(7):848-853.