腹腔镜D2根治术联合完整系膜切除术治疗进展期胃癌的临床疗效分析

目的分析腹腔镜D2根治术联合完整系膜切除术(CME)治疗进展期胃癌的临床疗效。方法回顾性分析2018-01~2018-12于郑州大学第二附属医院行腹腔镜治疗的80例胃癌患者的临床资料,根据接受术式不同分为研究组(采用腹腔镜下D2根治术+CME治疗)和对照组(采用腹腔镜下标准D2根治术治疗),每组40例。比较两组手术时间、术中出血量、淋巴结清扫个数、术后功能恢复情况、术后并发症发生率以及术后1年生存情况。结果与对照组相比,研究组手术时间更短,术中出血量更少,淋巴结清扫个数更多,差异有统计学意义(P<0.05)。研究组首次排气时间、首次进食时间和住院时间显著短于对照组(P<0.05),腹腔引流管引流量显著少于对照组(P<0.05)。研究组术后并发症发生率显著低于对照组(22.50%vs 52.50%;χ²=10.912,P=0.000)。在随访过程中,研究组有8例(20.00%)出现肿瘤复发,对照组有16例(40.00%)出现肿瘤复发;研究组有2例(5.00%)死亡,对照组有5例(12.50%)死亡。log-rank检验结果显示,两组术后生存情况差异无统计学意义(χ²=2.735,P=0.143)。结论与标准D2根治术相比,D2根治术+CME术式手术时间更短,术中出血量更少,淋巴结清扫更彻底,术后肠道功能恢复更快,且术后并发症更少,值得临床推荐。

Analysis of clinical efficacy of laparoscopic D2 radical resection combined with complete mesocolic excision in treatment of advanced gastric cancer

Objective To analyze the clinical efficacy of laparoscopic D2 radical resection combined with complete mesocolic excision(CME)in treatment of advanced gastric cancer.Methods The clinical data of 80 patients with gastric cancer who underwent therapeutic laparoscopy in the Second Affiliated Hospital of Zhengzhou University from January 2018 to December 2018 were retrospectively analyzed.The patients were divided into the study group(receiving laparoscopic D2 radical resection+CME treatment)and the control group(treated with standard D2 radical resection under laparoscopic surgery)according to different surgical procedures,with 40 cases in each group.The operation time,intraoperative blood loss,number of lymph node dissection,postoperative functional recovery,incidence of postoperative complications and one-year survival after surgery were compared between the two groups.Results Compared with the control group,the study group had shorter operation time,less intraoperative blood loss,and more lymph node dissections,and the differences were statistically significant between the two groups(P<0.05).The first exhaust time,the first feeding time and hospitalization time of the study group was significantly shorter than that of the control group(P<0.05),and the drainage volume of the abdominal cavity drainage tube of the study group was significantly less than that of the control group(P<0.05).The incidence of postoperative complications in the study group was significantly lower than that in the control group(22.50%vs 52.50%;χ²=10.912,P=0.000).During the follow-up,8 cases(20.00%)in the study group had tumor recurrence,and 16 cases(40.00%)in the control group had tumor recurrence;2 cases(5.00%)in the study group died,and 5 cases(12.50%)in the control group died.The results of log-rank test showed that there was no significant difference in postoperative survival between the two groups(χ²=2.735,P=0.143).Conclusion Compared with standard D2 radical resection,D2 radical resection+CME surgical procedure has shorter operation time,less intraoperative blood loss,more lymph node dissections,faster postoperative intestinal function recovery,and less postoperative complications.D2 radical resection+CME surgical procedure is worthy of clinical recommendation.