胃小弯全切术在远端胃癌根治术中的应用

目的探讨胃小弯全切术在远端胃癌根治术中的应用。方法将120例远端胃癌（进展期胃癌）患者随机分为两组，分别行胃小弯全切根治术（A组）和传统根治术（B组），并对治疗结果进行对比。结果术后1年生存率，A、B两组分别为89．2％，76.5％，术后2年生存率，A组为79．4％，B组为62．3％，差异均有显著性意义（P〈0.05）。A组60例患者共清除1597枚淋巴结，平均每例清除26．6枚，B组共清除960枚淋巴结，平均每例清除16．0枚，差异有显著性意义（P〈0．05）。术后并发反流性胃炎、倾倒综合征、吻合口漏A组分别为6．5％，3．3％，1．7％，B组分别为6．8％，4．7％，3．3％（P〉0．05）；术后吻合口复发率A、B两组分别为1．6％，8.3％（P〈0．05）；术后A组无切缘癌细胞残留，B组4例（6．7％）有切缘癌细胞残留（P〈0．05）。结论根治性胃小弯全切除术可以较彻底地清除转移的淋巴结，降低切缘癌细胞残留，降低复发率，提高患者生存率。

Total Resection of Lesser Curvature for Radical Treatment of Distal Gastric Carcinoma

Objective To investigate the clinical outcomes of total resection of lesser curvature used for radical treatment of distal gastric carcinoma.Methods A retrospective review was performed in 120 patients with distal advanced gastric carcinoma undergoing radical gastric surgery.The patients were randomized to receive either total resection of lesser curvature(group A,n=60) or traditional radical surgery(group B,n=60).The surgical outcomes were compared.Results There was no significant difference between the two groups in tumor location,size,clinical staging and tumor differentiation.One-and 2-year survival rates after operation were 89.2 % and 76.5 % in group A and 79.4 % and 62.3 % in group B,respectively with the difference being significant between two groups(P<0.05).In group A,1 597 lymph nodes were dissected,with an average of 26.6 lymph nodes dissected for each patient,and in group B total 960 lymph nodes were dissected,with an average of 16.0 for each patient with the difference being significant between two groups(P<0.05).The occurrence of postoperative reflux gastritis,dumpling syndrome and anastomotic leak was 6.5 %,3.3 % and 1.7 % in group A versus 6.8 %,4.7 % and 3.3 % in group B(P>0.05).The recurrence rate around anastomotic area was 1.6 % versus 8.3 % in group A versus group B(P<(0.05).) In group A,no tumor invasion in resection margin occurred,but 4 patients(6.7 %) had tumor invasion in resection margin in group B(P<0.05).Conclusion The total resection of lesser curvature performed in radical surgery of distal gastric carcinoma can decrease tumor recurrence,prevent tumor invasion in resection margin,increase the R0 resection rate and prolong survival time.