进展期胃上部癌患者行腹腔镜保脾脾门淋巴结环周清扫术的安全性及疗效分析

目的:探讨进展期胃上部癌患者行腹腔镜保脾脾门淋巴结环周清扫术的安全性及疗效。方法:回顾性分析2014年1月—2018年1月福建省莆田市第一医院胃肠外科一区169例行腹腔镜下保脾脾门淋巴结清扫术的进展期胃上部癌患者资料,其中92例仅清扫脾门前方淋巴结(对照组),另77例行脾门环周清扫,即在常规清扫脾门前方淋巴结的同时加做脾门后方的淋巴结清扫(观察组)。比较两组患者的相关临床指标。结果:两组患者的基线具可比性。两组在总手术时间、术中出血量、术后排气时间、术后进流质时间、术后住院时间、阳性淋巴结数方面均无统计学差异(均P0.05);与对照组比较,观察组脾门淋巴结清扫时间显明显延长,但淋巴结清扫总数、收获脾门淋巴结阳性患者例数、脾门淋巴结清扫数目均增加(均P0.05)。两组并发症发生率无统计学差异(P0.05),两组均无围手术期死亡病例。结论:进展期胃上部癌患者行腹腔镜保脾脾门淋巴结环周清扫术安全可行,同时能够避免脾门阳性淋巴结的遗漏。

Analysis of safety and efficacy of laparoscopic spleen-preserving circumferential splenic hilar lymph node dissection for patients with advanced proximal gastric cancer

Objective: To investigate the safety and efficacy of laparoscopic spleen-preserving circumferential splenic hilar lymph node dissection in treatment of patients with advanced proximal gastric cancer. Methods: The clinical data of 169 patients with advanced proximal gastric cancer who underwent laparoscopic spleen-preserving splenic hilar lymph node dissection in the First Division of the Gastrointestinal Surgery of the First Hospital of Putian City from January 2014 to January 2018 were retrospectively analyzed. Of the patients, 92 cases underwent laparoscopic anterior splenic hilar lymph node dissection (control group), while the other 77 cases underwent laparoscopic circumferential splenic hilar lymph node dissection, namely, underwent the conventional anterior splenic hilar lymph node dissection simultaneously with posterior splenic hilar lymph node dissection (observation group). The main clinical variables between the two groups of patients were compared. Results: The baseline data between the two groups of patients were comparable. There were no significant differences between the two groups in terms of total operative time, intraoperative blood loss, time to postoperative gas passage, time to postoperative liquid food intake, length of postoperative hospital stay and number of positive lymph nodes (all P>0.05). In observation group compared with control group, the time for splenic hilar lymph node dissection was significantly prolonged, but the number of total dissected lymph nodes, the number of cases with positive splenic hilar lymph nodes and total number of harvested splenic hilar lymph nodes were significantly increased (all P<0.05). The incidence rates of complication showed no significant difference between the two groups (P>0.05). No perioperative death occurred in the two groups. Conclusion: Laparoscopic spleen-preserving circumferential splenic hilar lymph node dissection is safe and effective for patients with advanced proximal gastric cancer, and it can help avoid the incomplete dissection of positive splenic hilar lymph nodes.