腹腔镜微创手术治疗局部进展期食管胃交界部腺癌术中腹腔冲洗灭菌注射用水用量对疗效的影响

目的:探讨术中灭菌注射用水在腹腔冲洗中的用量对腹腔镜微创手术治疗局部进展期食管胃交界部腺癌(AEG)患者疗效的影响.方法:选取2013年10月至2014年12月行腹腔镜手术治疗的进展期AEG患者120例,按照灭菌注射用水在腹腔冲洗中的用量分为4组,每组30例.A组:1000 mL;B组:3000 mL;C组:5000 ...

Evaluation of the effect of amounts of sterile water for injection for celiac irrigation in laparoscopic treatment of local advanced adenocarcinoma of esophagogastric junction

Objective:To evaluate the effect of the amount of sterile water for injection for celiac irrigation in laparoscopic treatment of local advanced adenocarcinoma of esophagogastric junction(AEG).Methods:120 patients with advanced AEG who had celiac irrigation underwent laparoscopic surgery from October 2013 to December 2014 were selected and divided into 4 groups according to the amount of sterile water for injection,with 30 patients in each group,including group A with 1000 mL,group B with 3000 mL,group C with 5000 mL,group D with 10000 mL.The incidence of surgical complications and adverse reactions,postoperative local recurrence rate,metastasis rate and progression-free survival rate of the 4 groups were compared.Results:There was no significant difference in the incidence of surgical complications and adverse reactions among the 4 groups(P>0.05).There was no significant difference in liver metastasis rate and 1-year progression-free survival rate among the 4 groups(P>0.05),while there was no significant difference in local recurrence rate,metastasis rate and progression-free survival rate between the A and B groups(P>0.05),and there was also no significant difference in local recurrence rate,metastasis rate and progression-free survival rate between groups C and D(P>0.05).However,the local recurrence rate and peritoneal metastasis rate in C and D groups were lower than those in A and B groups,and the 3-year and 5-year progression-free survival rates were higher than those in A and B groups(P<0.05).According to the depth of tumor invasion and stratification of lymph node metastasis,there was no significant difference in local recurrence rate,metastasis rate and progression-free survival rate amang 4 groups in T 2 stage and those without lymph node metastasis(P>0.05).There was no significant difference in liver metastasis rate and 1-year progression-free survival amang 4 groups in T 3 or T 4a stage and those with lymph node metastasis(P>0.05).In the deeper tumor invasion with T 3 or T 4a stage,and in patients with lymph node metastasis,but local recurrence rate and celiac metastasis rate in C and D groups were lower than group A and B(P<0.05),3-year and 5-year progression-free survival rates were higher than in A and B group(P<0.05),and also peritoneal metastasis rate of group D was lower than that of group C(P<0.05),3-year and 5-year progression-free survival rates were higher than that of group C(P<0.05).Conclusion:We can effectively reduce local recurrence rate and celiac metastasis rate,improve progression-free survival,associated with the increase of the amount of sterile water for injection for celiac irrigation in laparoscopic treatment of patients with local advanced AEG.But it was useless to reduce liver metastasis rate.We should especially advocate using large amount of sterile water for injection to irrigate abdominal cavity during laparoscopic operation on AEG patients with deeper tumor invasion and lymph node metastasis.