开放与腹腔镜全胃联合胰体尾、脾切除术治疗T4b期胃癌的近中期疗效比较

目的比较开腹与腹腔镜全胃联合胰体尾、脾切除术治疗T4b期胃癌的近中期疗效。方法回顾性分析2017年5月至2019年11月接受手术治疗的117例T4b期胃癌病例资料,根据术式不同分为腹腔镜组(n=56例,腹腔镜全胃联合胰体尾、脾切除术)和开腹组(n=61例,开腹全胃联合胰体尾、脾切除术)。使用SPSS 23.0统计软件分析数据,围手术期相关指标等计量资料以(x±s)表示,采用独立样本t检验;术后并发症等计数资料采用χ²检验;累积生存率采用Log Rank检验。P<0.05为差异有统计学意义。结果腹腔镜组手术时间高于开腹组,患者术中出血量、术后排气时间、术后进食时间、住院时间均少于较开腹组,差异有统计学意义(P<0.05)。两组患者阳性淋巴结清扫数量、术后并发症总发生率和术后2年总生存率(41.1%VS.39.3%)差异均无统计学意义(P>0.05).结论腹腔镜全胃联合胰体尾、脾切除术治疗T4b期胃癌具有一定可行性,与开腹手术相比,具有一定微创优势,且并未增加并发症风险,但在改善预后方面无明显优势。

Comparison of short-term and medium-term efficacy of open and laparoscopic total gastrectomy combined with distal pancreatectomy and splenectomy in the treatment of T4b gastric cancer

Objective To compare the short-and mid-term efficacy of open and laparoscopic total stomach combined with pancreatic tail splenectomy for T4b gastric cancer.Methods The data of 117 patients with T4B gastric cancer who underwent surgery from May 2017 to November 2019 were analyzed retrospectively.According to different surgical methods,they were divided into laparoscopic group(n=56 cases,Laparoscopic total stomach combined pancreatic body tail and splenectomy)and open group(n=61 cases,open total stomach combined pancreatic body tail and splenectomy).SPSS 23.0 statistical software was used for analysis,the measurement data such as perioperative related indicators were expressed as(x±s),and the independent sample t test was used.Postoperative complications were counted by χ² test.The cumulative survival rate was used by Log Rank test.P<0.05 was considered statistically significant.Results The operation time in the laparoscopic group was higher than that in the open group,and the amount of intraoperative blood loss,postoperative exhaust time,postoperative eating time,and hospital stay were lower than those of the open group,with statistical significance.(P<0.05).There were no significant differences in the number of positive lymph node dissections,the total incidence of postoperative complications and the 2-year overall survival rate(41.1%vs.39.3%)between two groups(P>0.05).Conclusion Laparoscopic total stomach combined with pancreatic body tail splenectomy is feasible for T4b gastric cancer.Compared with open surgery,it has certain minimally invasive advantages and does not increase the risk of complications,but it has no obvious advantage in improving prognosis.