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

目的 比较腹腔镜与开腹全胃切除术联合D2淋巴结清扫治疗中上部进展期胃癌的分子学疗效及预后。方法 选择90例中上部进展期胃癌患者，按照随机数字表法分为观察组和对照组，每组45例。观察组患者采用腹腔镜全胃切除术联合D2淋巴结清扫治疗，对照组患者采用开腹全胃切除术联合D2淋巴结清扫治疗。比较两组患者手术前后血清癌胚抗原（CEA）、CA125、CA199、CA724的水平和阳性率，手术相关指标及预后情况（并发症发生率、生存率和复发率等）。结果 与术前比较，术后两组患者的血清CEA、CA125、CA199、CA724水平和阳性率均下降，且观察组下降幅度更大，差异有统计学意义（P﹤0.01）；观察组患者的手术时间长于对照组，而术中出血量、肛门排气时间、住院时间、胃肠功能恢复时间和淋巴结清扫数量均低于对照组，差异有统计学意义（P﹤0.05）；观察组患者的并发症总发生率低于对照组（8.89% vs 28.89%），差异有统计学意义（P﹤0.05）；随访14个月，两组患者的生存率和复发率比较，差异无统计学意义（P﹥0.05）。结论 采用腹腔镜全胃切除术结合D2淋巴结清扫治疗中上部进展期胃癌，可以明显提高临床疗效，减少并发症，患者预后良好，值得临床推广应用。

Molecular efficacy and prognosis of laparoscopic and open total gastrectomy combined with D2 lymphadenectomy in the treatment of advanced gastric cancer in middle-upper part

Objective To compare the molecular efficacy of D2 lymphadenectomy-based laparoscopic and open total gastrectomy in the treatment of advanced gastric cancer(AGC)in middle-upper part and the prognosis.Method 90 pa-tients diagnosed with AGC in middle-upper part were randomized as study group or control group,with 45 cases in each. The study group was given laparoscopic total gastrectomy combined with D2 lymphadenectomy,while control group was administered with open total gastrectomy and D2 lymphadenectomy. The level of serum carcinoembryonic antigen (CEA),CA125,CA199,and CA724 and positive rates before and after surgery,surgical indexes(including incidence of complications,survival rate,and recurrence rate)were compared between the two groups.Result Compared with before surgery,the level of serum CEA,CA125,CA199,and CA724 and positive rates were decreased in both groups after sur-gery,with higher reduction observed in study group,and the difference was statistically significant(P<0.01);the opera-tive time of study group was longer than that of control group,while the intraoperative blood loss,time to anal exhaust, hospital stay,time to gastrointestinal function recovery,and the number of lymph node dissection in study group were all less than those in control group(P<0.05);less complications were observed in study group than control group(8.89% vs 28.89%), with significant difference observed (P<0.05); after 14 months of follow-up, the survival rate and recurrence rate in the two groups were similar(P>0.05).Conclusion Laparoscopic total gastrectomy combined with D2 lymphade-nectomy can remarkably improve the clinical efficacy in treating advanced gastric cancer of middle and upper part,with less complications and better prognosis.