近端胃癌根治术中脾脏切除与脾脏保留的短期和长期效果

目的探讨近端胃癌根治术中脾脏切除与脾脏保留的短期及长期疗效。 方法回顾性分析2012年1月至2014年6月间行腹腔镜胃癌根治术患者43例资料，根据术式不同分为保脾组20例，切脾组23例。采用统计软件SPSS 24.0进行数据分析，围术期各项指标和NO.10及NO.11淋巴结清扫数目采用( ±s)表示，独立样本t检验；术后并发症组间比较采用χ²检验；绘制两组1年、3年、5年总生存率及无病生存率Kaplan-Meier曲线图，采用Log-rank法检测；以P<0.05表示差异有统计学意义。 结果两组患者均成功完成手术，无中转开腹，无术后在院死亡病例，术后均完成随访。保脾组住院时间明显少于切脾组(P<0.05)，手术时间、术中出血量、肛门排气时间、淋巴结清扫数目及NO.10及NO.11淋巴结清扫数目两组比较差异均无统计学意义(P>0.05)；保脾组并发症发生率(7例，35.0%)明显少于切脾组(15例，65.2%), P<0.05；保脾组患者1年、3年、5年总生存率分别为80.0%、45.0%、40.0%，切脾组为82.6%、47.8%、39.1%(P>0.05)；保脾组患者1年、3年、5年无病生存率分别为75.0%、45.0%、35.0%，切脾组为78.3%、43.5%、34.8%，两组差异均无统计学意义(P>0.05)。 结论进展期近端胃癌根治术中脾脏切除与脾脏保留的效果比较，后者术后恢复更快，且并发症发生率较低，两者在淋巴结清扫的效果相同，远期预后相当。

The short-term and long-term effects of splenectomy and spleen preservation in radical gastrectomy for proximal gastric cancer

ObjectiveTo investigate the short-term and long-term efficacy of splenectomy and splenic preservation in radical resection of proximal gastric cancer. Methodsthe data of 43 patients who underwent laparoscopic radical gastrectomy for gastric cancer from January 2012 to June 2014 were retrospectively analyzed. According to the different operation methods, the patients were divided into the spleen-preserving group (20 cases) and the spleen-cutting group (23 cases). Statistical software SPSS 24.0 was used for data analysis. Indicators and number of No.10 and No.11 lymph nodes dissected during the perioperative period were expressed as ( ±s), and independent sample t test was used. Postoperative complications between groups were compared by χ² test. The kaplan-meier curve of 1-year, 3-year and 5-year overall survival rate and disease-free survival rate of the two groups was drawn for log-rank detection. P<0.05 indicated that the difference was statistically significant. ResultsAll patients of two groups successfully completed the operation, no conversion to laparotomy, no postoperative death in hospital, all completed follow-up. There was no significant difference in the time of operation, the amount of bleeding during operation, the time of anal exhaust, the number of lymph node dissection and the number of No.10 and No.11 lymph node dissection (P>0.05); the incidence of complications in the group of spleen preservation (7 cases, 35.0%) was significantly lower than that in the group of spleen resection (15 cases, 65.2%) (P<0.05). The 1-year, 3-year and 5-year overall survival rates of patients in the spleen group were 80.0%, 45.0% and 40.0%, respectively, and those in the spleen cutting group were 82.6%, 47.8% and 39.1%, respectively, with no statistical difference between the two groups (P>0.05); the 1-year, 3-year and 5-year disease-free survival rates of patients in the spleen protecting group were 75.0%, 45.0% and 35.0%, respectively, and those in the spleen cutting group were 78.3%, 43.5% and 34.8%, respectively, with no statistical difference between the two groups (P>0.05). ConclusionCompared with the effect of splenectomy and spleen preservation in the radical operation of advanced proximal gastric cancer, the latter has a faster recovery and a lower incidence of complications.And they havethe same effect in lymph node dissection and the same long-term prognosis.