远端胃癌第12组淋巴结廓清术不同手术 入路的临床疗效和安全性分析

目的探讨不同手术入路用于远端胃癌肝十二指肠韧带淋巴结（第12组）清扫的安全性及临床疗效。方法选取确诊远端胃癌病人88例，随机分为3组行胃癌根治术（D2+经不同手术入路行第12组淋巴结清扫），其中前入路组30例，后入路组26例，右侧入路组32例。针对3组病人的第12组淋巴结清扫手术时间、术中出血量、清扫第12组淋巴结数目、术后肛门排气时间、术后住院时间及并发症发生率等因素进行统计学分析。结果3组年龄、性别、术后病理分期差异均无统计学意义（P>0.05）。3组淋巴结清扫数目、术后肛门排气时间和术后住院时间差异均无统计学意义（P>0.05）。后入路组术中第12组淋巴结清扫时间和出血量均少于其他2组（P < 0.05~P < 0.01），后入路组术中和术后总并发症发生率低于其他2组（P < 0.05）。结论后入路法在远端胃癌第12组淋巴结清扫中清扫时间短、出血量少，并发症发生率低，有一定的临床推广价值。

Clinical efficacy and safety analysis of different surgical approaches in No.12 lymph node dissection of distal gastric cancer

ObjectiveTo explore the clinical efficacy and safety of different surgical approaches in hepatoduodenal ligament lymph node(No.12 group) dissection of distal gastric cancer.MethodsEighty-eight patients with distal gastric cancer were treated with radical gastrectomy of cancer, and randomly divided into three groups according to different surgical approaches, which included anterior approach group(30 cases), posterior approach group(26 cases) and right approach group(32 cases).The operation time of No.12 lymph node dissection, intraoperative blood loss, number of lymph nodes dissection, postoperative anal exhaust time, postoperative hospital stay and incidence rate of complications were analyzed among three groups.ResultsThe differences of the age, gender and postoperative pathological staging, number of lymph nodes dissection, postoperative anal exhaust time and postoperative hospital stay were not statistically significant among three groups(P>0.05).The operation time of No.12 lymph node dissection and intraoperative blood loss in posterior approach group were less than those in other two groups(P < 0.05 to P < 0.01), and the incidence rates of total complications during and after operation in posterior approach group were lower than those in other two groups(P < 0.05).ConclusionsNo.12 lymph node dissection of distal gastric cancer has short operation time, little bleeding volume and low incidence of complication, which is worthy of promotion in clinic.