原发性胃癌腹腔镜下淋巴结清扫的效果分析
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摘要
目的比较原发性胃癌患者腹腔镜下根治术与传统开腹胃癌根治术对淋巴结清扫的效果,为临床胃癌患者根治术的选择提供参考。方法选择2012年5月-2017年12月在该院择期行胃癌根治术的患者126例为研究对象,根据其手术方式的不同分为观察组和对照组,其中观察组65例,采用腹腔镜根治术;对照组61例,采用开腹根治术。比较两组患者淋巴结清扫情况、切口长度、术中失血量、手术时间、术后住院时间、术后下床活动时间、排气时间、术后并发症及肿瘤复发率。结果观察组与对照组在清扫淋巴结总数上差异无统计学意义(t=-0.89,P=0.373);在第1站清扫数上差异无统计学意义(t=-0.23,P=0.815);在第2站清扫数上差异无统计学意义(t=-1.71,P=0.089),腹腔镜手术少于开腹手术。观察组患者的切口长度、术中失血量、术后住院时间、术后下床活动时间及排气时间明显小于对照组,差异均有统计学意义(P<0.05);观察组患者的手术时间长于对照组患者,差异有统计学意义(P<0.05)。观察组并发症发生率为6.2%,其中切口感染1例,胸腔积液1例,肺部感染2例。对照组并发症的发生率为9.8%,其中切口感染2例,胸腔积液1例,腹腔出血1例,肺部感染2例,两组比较,差异无统计学意义(χ2=0.58,P=0.445)。结论腹腔镜胃癌根治术可达到与开腹手术同样的淋巴结清扫效果,且具有创伤小和恢复快等优点,可用于治疗原发性胃癌。
Objective To compare the effect of laparoscopic radical gastrectomy and traditional radical gastrectomy for lymph node dissection in patients with primary gastric cancer,and provide a reference for the choice of radical surgery for the patients with gastric cancer.Methods 126 patients who underwent radical gastrectomy for gastric cancer from May 2012 to December 2017 were selected as the study subjects.According to the different surgical methods,the patients were divided into observation group and control group.Among them,65 cases in the observation group were treated with laparoscopic radical surgery,and 61 cases in the control group were treated with open radical operation.The two groups were compared with the lymph node dissection,the length of the incision,the amount of blood loss,the time of operation,the time of hospitalization after operation,the time after the operation,the time of discharge from the bed,the time of exhaust,the postoperative complications and the recurrence rate of the tumor.Results There was no significant difference in the total number of lymph nodes between the observation group and the control group on the total number of lymph nodes(t=-0.89,P=0.373),and There was no statistically significant difference between the first and two stations(t=-0.23,-1.71,P=0.815,0.089).The length of the incision,the amount of blood loss,the time of hospitalization,the time of postoperative hospital stay,the time and the exhaust time were all smaller than those of the control group(P<0.05),and the operation time of the patients in the observation group was longer than that of the control group,the difference was statistically significant(P<0.05).The complication rate of the observation group was 6.2%,including 1 cases of incision infection,1 cases of pleural effusion,and 2 cases of pulmonary infection.The incidence of complications in the control group was 9.8%,including incision infection in 2 cases,pleural effusion in 1 case,abdominal bleeding in 1 cases,and pulmonary infection in 2 cases.There was no significant difference between the two groups(χ2=0.58,P=0.445).Conclusion Laparoscopic radical gastrectomy can achieve the same effect of lymph node dissection as open surgery,and it has the advantages of small trauma and quick recovery.It can be used for the treatment of primary gastric cancer.
Objective To compare the effect of laparoscopic radical gastrectomy and traditional radical gastrectomy for lymph node dissection in patients with primary gastric cancer,and provide a reference for the choice of radical surgery for the patients with gastric cancer.Methods 126 patients who underwent radical gastrectomy for gastric cancer from May 2012 to December 2017 were selected as the study subjects.According to the different surgical methods,the patients were divided into observation group and control group.Among them,65 cases in the observation group were treated with laparoscopic radical surgery,and 61 cases in the control group were treated with open radical operation.The two groups were compared with the lymph node dissection,the length of the incision,the amount of blood loss,the time of operation,the time of hospitalization after operation,the time after the operation,the time of discharge from the bed,the time of exhaust,the postoperative complications and the recurrence rate of the tumor.Results There was no significant difference in the total number of lymph nodes between the observation group and the control group on the total number of lymph nodes(t=-0.89,P=0.373),and There was no statistically significant difference between the first and two stations(t=-0.23,-1.71,P=0.815,0.089).The length of the incision,the amount of blood loss,the time of hospitalization,the time of postoperative hospital stay,the time and the exhaust time were all smaller than those of the control group(P<0.05),and the operation time of the patients in the observation group was longer than that of the control group,the difference was statistically significant(P<0.05).The complication rate of the observation group was 6.2%,including 1 cases of incision infection,1 cases of pleural effusion,and 2 cases of pulmonary infection.The incidence of complications in the control group was 9.8%,including incision infection in 2 cases,pleural effusion in 1 case,abdominal bleeding in 1 cases,and pulmonary infection in 2 cases.There was no significant difference between the two groups(χ2=0.58,P=0.445).Conclusion Laparoscopic radical gastrectomy can achieve the same effect of lymph node dissection as open surgery,and it has the advantages of small trauma and quick recovery.It can be used for the treatment of primary gastric cancer.
引文
[1]王胤奎,李子禹,陕飞,等.我国早期胃癌的诊治现状-来自中国胃肠肿瘤外科联盟数据的启示[J].中华胃肠外科杂志,2018,21(2):168-174.[1]WANG Y K,LI Z Y,SHAN F,et al.Current status of diagnosis and treatment of early gastric cancer in China the data from China gastrointestinal cancer surgery union[J].Chinese Journal of Gastrointestinal Surgery,2018,21(2):168-174.Chinese
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[7]TSUCHIYA N,KUNISAKI C,MAKINO H,et al.Feasibility of Laparoscopy-assisted gastrectomy for gastric cancer in elderly patients:a case-control study[J].Surg Laparosc Endosc Percutan Tech,2018,28(2):102-107.
[8]余铭,薛迪新,施正超,等.腹腔镜下胃癌D2淋巴结清扫的临床疗效及中期随访报告[J].中国内镜杂志,2017,23(11):68-73.[8]YU M,XUE D X,SHI Z C,et al.Medium-term follow-up of laparoscopic surgery on radical gastrectomy with D2 dissection for gastric cancer[J].China Journal of Endoscopy,2017,23(11):68-73.Chinese
[9]林琳,许庆文,徐飞鹏,等.腹腔镜与开腹全胃切除术联合D2淋巴结清扫在中上部进展期胃癌中的分子学疗效及预后分析[J].癌症进展,2018,16(1):77-80.[9]LIN L,XU Q W,XU F P,et al.Molecular efficacy and prognosis of laparoscopic and open total gastrectomy combined with D2lymphadenectomy in the treatment of advanced gastric cancer in middle-upper part[J].Oncology Progress,2018,16(1):77-80.Chinese
[10]沈韧斌,徐伟.腹腔镜与开腹胃癌根治术对区域淋巴结清扫及并发症的影响比较[J].中华普外科手术学杂志:电子版,2017,11(6):472-474.[10]SHEN R B,XU W.Comparative study of complications after laparoscopy and open gastrectomy with regional lymphadenectomy[J].Chinese Journal of Operative Procedures of General Surgery:Electronic Edition,2017,11(6):472-474.Chinese
[11]黄昌明,郑志芳,林密.腹腔镜胃癌根治术保脾脾门淋巴结清扫术[J].中华普外科手术学杂志:电子版,2017,11(6):464.[11]HUANG C M,ZHENG Z F,LIN M.Laparoscopic gastrectomy with spleen-preserving hilar lymph node dissection for gastric cancer[J].Chinese Journal of Operative Procedures of General Surgery:Electronic Edition,2017,11(6):464.Chinese
[12]薛飞,时雨,赵爽.腹腔镜辅助与手辅助腹腔镜手术行胃癌根治术的效果比较[J].安徽医学,2018,39(1):99-102.[12]XUE F,SHI Y,ZHAO S.Comparison of laparoscopic assisted and hand assisted laparoscopic radical gastrectomy for gastric cancer[J].Anhui Medical Journal,2018,39(1):99-102.Chinese
[13]ARATANI K,SAKURAMOTO S,CHUMAN M,et al.Laparoscopy-assisted distal gastrectomy for gastric cancer in elderly patients:surgical outcomes and prognosis[J].Anticancer Res,2018,38(3):1721-1725.
[14]李靖锋,朱志贤,唐俊,等.腹腔镜辅助远端胃癌根治术的临床疗效及对患者免疫功能的影响[J].实用癌症杂志,2017,32(11):1824-1827.[14]LI J F,ZHU Z X,TANG J,et al.Clinical effect and influence on the immune function of laparoscopic-assisted gastrectomy for distant gastric cancer[J].The Practical Journal of Cancer,2017,32(11):1824-1827.Chinese
[15]王俊江,李晓武,冯兴宇,等.腹腔镜和开腹D2胃癌根治术淋巴结清扫效果分析[J].中华消化外科杂志,2017,16(11):1144-1148.[15]WANG J J,LI X W,FENG X Y,et al.Effect analysis of laparoscopy-assisted and open D2 radical gastrectomy for gastric cancer[J].Chinese Journal of Digestive Surgery,2017,16(11):1144-1148.Chinese
[2]李国新,陈新华,余江,等.中国、日本和韩国腹腔镜胃癌外科临床研究现状[J].中华胃肠外科杂志,2018,21(2):126-131.[2]LI G X,CHEN X H,YU J,et al.Clinical research status of laparoscopic gastric cancer surgery in China,Japan and South Korea[J].Chinese Journal of Gastrointestinal Surgery,2018,21(2):126-131.Chinese
[3]李智永,郭梅娟,杜太平,等.腹腔镜全胃切除D2淋巴结清除术治疗进展期胃癌的临床观察[J].中国现代普通外科进展,2017,20(9):730-732.[3]LI Z Y,GUO M J,DU T P,et al.Clinical observation of laparoscopic total gastrectomy and D2 lymph node dissection for advanced gastric cancer[J].Chinese Journal of Current Advances in General Surgery,2017,20(9):730-732.Chinese
[4]赵刚,武青生,穆元忠,等.腹腔镜辅助下D2根治术对进展期远端胃癌患者临床疗效、术后并发症及住院时间的影响[J].癌症进展,2017,15(11):1335-1337.[4]ZHAO G,WU Q S,MU Y Z,et al.The effect of laparoscopic assisted radical D2 resection on the clinical efficacy,postoperative complications and hospital stay in patients with advanced distal gastric cancer[J].Oncology Progress,2017,15(11):1335-1337.Chinese
[5]黄昌明,林密.腹腔镜下脾门淋巴结清扫的技术要点-CLASS-04研究设计的初衷[J].中华胃肠外科杂志,2018,21(2):143-147.[5]HUANG C M,LIN M.Technical points of laparoscopic splenic hilar lymph node dissection-the original intention of CLASS-04research design[J].Chinese Journal of Gastrointestinal Surgery,2018,21(2):143-147.Chinese
[6]BRENKMAN H J F,GERTSEN E C,VEQT E,et al.Evaluation of PET and laparoscopy in STagIng advanced gastric cancer:a multicenter prospective study(PLASTIC-study)[J].BMC Cancer,2018,18(1):450.
[7]TSUCHIYA N,KUNISAKI C,MAKINO H,et al.Feasibility of Laparoscopy-assisted gastrectomy for gastric cancer in elderly patients:a case-control study[J].Surg Laparosc Endosc Percutan Tech,2018,28(2):102-107.
[8]余铭,薛迪新,施正超,等.腹腔镜下胃癌D2淋巴结清扫的临床疗效及中期随访报告[J].中国内镜杂志,2017,23(11):68-73.[8]YU M,XUE D X,SHI Z C,et al.Medium-term follow-up of laparoscopic surgery on radical gastrectomy with D2 dissection for gastric cancer[J].China Journal of Endoscopy,2017,23(11):68-73.Chinese
[9]林琳,许庆文,徐飞鹏,等.腹腔镜与开腹全胃切除术联合D2淋巴结清扫在中上部进展期胃癌中的分子学疗效及预后分析[J].癌症进展,2018,16(1):77-80.[9]LIN L,XU Q W,XU F P,et al.Molecular efficacy and prognosis of laparoscopic and open total gastrectomy combined with D2lymphadenectomy in the treatment of advanced gastric cancer in middle-upper part[J].Oncology Progress,2018,16(1):77-80.Chinese
[10]沈韧斌,徐伟.腹腔镜与开腹胃癌根治术对区域淋巴结清扫及并发症的影响比较[J].中华普外科手术学杂志:电子版,2017,11(6):472-474.[10]SHEN R B,XU W.Comparative study of complications after laparoscopy and open gastrectomy with regional lymphadenectomy[J].Chinese Journal of Operative Procedures of General Surgery:Electronic Edition,2017,11(6):472-474.Chinese
[11]黄昌明,郑志芳,林密.腹腔镜胃癌根治术保脾脾门淋巴结清扫术[J].中华普外科手术学杂志:电子版,2017,11(6):464.[11]HUANG C M,ZHENG Z F,LIN M.Laparoscopic gastrectomy with spleen-preserving hilar lymph node dissection for gastric cancer[J].Chinese Journal of Operative Procedures of General Surgery:Electronic Edition,2017,11(6):464.Chinese
[12]薛飞,时雨,赵爽.腹腔镜辅助与手辅助腹腔镜手术行胃癌根治术的效果比较[J].安徽医学,2018,39(1):99-102.[12]XUE F,SHI Y,ZHAO S.Comparison of laparoscopic assisted and hand assisted laparoscopic radical gastrectomy for gastric cancer[J].Anhui Medical Journal,2018,39(1):99-102.Chinese
[13]ARATANI K,SAKURAMOTO S,CHUMAN M,et al.Laparoscopy-assisted distal gastrectomy for gastric cancer in elderly patients:surgical outcomes and prognosis[J].Anticancer Res,2018,38(3):1721-1725.
[14]李靖锋,朱志贤,唐俊,等.腹腔镜辅助远端胃癌根治术的临床疗效及对患者免疫功能的影响[J].实用癌症杂志,2017,32(11):1824-1827.[14]LI J F,ZHU Z X,TANG J,et al.Clinical effect and influence on the immune function of laparoscopic-assisted gastrectomy for distant gastric cancer[J].The Practical Journal of Cancer,2017,32(11):1824-1827.Chinese
[15]王俊江,李晓武,冯兴宇,等.腹腔镜和开腹D2胃癌根治术淋巴结清扫效果分析[J].中华消化外科杂志,2017,16(11):1144-1148.[15]WANG J J,LI X W,FENG X Y,et al.Effect analysis of laparoscopy-assisted and open D2 radical gastrectomy for gastric cancer[J].Chinese Journal of Digestive Surgery,2017,16(11):1144-1148.Chinese