胃癌根治术中网膜囊切除对进展期胃癌患者预后的影响
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摘要
目的探究胃癌根治术中网膜囊切除对进展期胃癌患者预后的影响。方法选取2014年10月至2015年9月在我科行胃癌根治术的117例患者,依据是否切除网膜囊分为试验组(62例)及对照组(55例),完成3年随访,分析并比较患者的手术相关指标及预后情况。结果试验组的术后第1天引流量、术后常规病理检出淋巴结数目显著多于对照组,差异有统计学意义(P<0.05)。两组患者术后1、2、3年生存率比较,差异均无统计学意义(P>0.05);但试验组中胃后壁肿瘤患者3年的生存率高于对照组,差异有统计学意义(P<0.05)。结论对进展期胃癌患者行胃癌根治术联合网膜囊切除是安全、可行的,可延长胃后壁肿瘤患者的生存时间,改善预后,值得临床应用。
Objective To investigate the effect of omental sac resection on prognosis of patients with advanced gastric cancer during radical gastrectomy. Methods The patients who underwent radical gastrectomy in our department from October 2014 to September 2015 were selected, according to omental sac resection was excised or not, the patients were divided into experimental group(62 cases) and control group(55 cases). A 3-year follow-up was completed, and surgical related indicators and prognosis of patients were analyzed and compared. Results The drainage volume on the first day after operation and the number of lymph nodes detected by routine pathology after operation in the observation group were higher than those in the control group, and the differences were statistically significant(P<0.05). There were no significant differences in the survival rate of 1, 2 and 3 years after operation between the two groups(P>0.05). However, the 3-year survival rate of patients with posterior gastric wall tumors in the observation group was higher than that in the control group, and the difference was statistically significant(P<0.05). Conclusion Radical gastrectomy combined with omental sac resection is safe and feasible for advanced gastric cancer patients. It can prolong survival time and improve prognosis for patients with posterior gastric wall tumors, which is worthy of clinical application.
Objective To investigate the effect of omental sac resection on prognosis of patients with advanced gastric cancer during radical gastrectomy. Methods The patients who underwent radical gastrectomy in our department from October 2014 to September 2015 were selected, according to omental sac resection was excised or not, the patients were divided into experimental group(62 cases) and control group(55 cases). A 3-year follow-up was completed, and surgical related indicators and prognosis of patients were analyzed and compared. Results The drainage volume on the first day after operation and the number of lymph nodes detected by routine pathology after operation in the observation group were higher than those in the control group, and the differences were statistically significant(P<0.05). There were no significant differences in the survival rate of 1, 2 and 3 years after operation between the two groups(P>0.05). However, the 3-year survival rate of patients with posterior gastric wall tumors in the observation group was higher than that in the control group, and the difference was statistically significant(P<0.05). Conclusion Radical gastrectomy combined with omental sac resection is safe and feasible for advanced gastric cancer patients. It can prolong survival time and improve prognosis for patients with posterior gastric wall tumors, which is worthy of clinical application.
引文
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[14]KUNG CH,LINDBLAD M,NILSSON M,et al.Postoperative pancreatic fistula formation according to ISGPF criteria after D2 gastrectomy in Western patients[J].Gastric Cancer,2014,17(3):571-577.
[15]韩方海,詹文华,何裕隆,等.胃癌根治手术网膜囊及筋膜切除问题[J]中国普通外科与临床杂志,2007,14(2):230-234.
[16]MASANORI T.Primary results of a phaseⅢtrial to evaluate bursectomy for patients with subserosal/serosal gastric cancer(JCOG1001)[J].J Clin Oncol,2017,35(suppl 4S):abstract 5.
[2]Association JGC.Japanese gastric cancer treatment guidelines 2014(ver.4)[J].Gastric Cancer,2017,20(1):1-19
[3]FUJITA J,KUROKAWA Y,SUGIMOTO T,et al.Survival benefit of bursectomy in patients with resectable gastric cancer:interim analysis results of a randomized controlled trial[J].Gastric Cancer,2012,15(1)42-48.
[4]LESLIE HS,MARY KG,CHRISTIAN W.TNM classification of malignant tumours,7th edition[M].New York:Wiley-Blackwell,2009,117-126.
[5]日本胃癌学会.胃癌取扱い規約[M].14版.東京:金原出版株式会社,2010.
[6]裘法祖,王健本,张祜曾.腹部外科临床解剖学[M].济南:山东科学技术出版社,2001:58.
[7]陈心足,杨昆,胡建昆,等.完成网膜囊切除在腹腔镜辅助胃癌根治术中的可行性与安全性[J].消化肿瘤杂志,2012,4(2):89-92.
[8]JAPANESE GASTRIC CANCER ASSOCIANTION.Japanese gastric cancertreatment guidelines 2010(ver.3)[J].Gastric Cancer,2011,14(2):113-123.
[9]IMAMURA H,KUROKAWA Y,KAWADA J,et al.Influence of bursectomy on operative morbidity and mortality after radical gastrectomy for gastric cancer:results of a randomized controlled trial[J].World J Surg,2011,35(3):625-630.
[10]HUNDAHL SA.The potential value of bursectomy in operations for Trans-serosal gastric adenocarcinoma[J].Gastric Cancer,2012,15(1):3-4.
[11]K BLOUHOS,KA BOULAS,A HATZIGEORGIADIS.Metastasis in lymph nodes on the anterior pancreatic surface of the body and tail:an extremely rare finding during bursectomy in extended surgery forgastric cancer[J].Updates in Surgery,2015,67(1):1-2.
[12]HERBELLA FA,TINELI AC,WILSON JL,et al.Gastrectomy and lymphadenectomy for gastric cancer:is the pancreas safe?[J].JGastrointest Surg,2008,12(11):1912-1914.
[13]KOMATSU S,ICHIKAWA D,KASHIMOTO K,et al.Risk factors to predict severe postoperative pancreatic fistula following gastrectomy for gastric cancer[J].World J Gastroenterol,2013,19(46):8696-8702.
[14]KUNG CH,LINDBLAD M,NILSSON M,et al.Postoperative pancreatic fistula formation according to ISGPF criteria after D2 gastrectomy in Western patients[J].Gastric Cancer,2014,17(3):571-577.
[15]韩方海,詹文华,何裕隆,等.胃癌根治手术网膜囊及筋膜切除问题[J]中国普通外科与临床杂志,2007,14(2):230-234.
[16]MASANORI T.Primary results of a phaseⅢtrial to evaluate bursectomy for patients with subserosal/serosal gastric cancer(JCOG1001)[J].J Clin Oncol,2017,35(suppl 4S):abstract 5.