腹腔镜辅助胃癌D2根治术联合胃背侧系膜近胃端完整系膜切除术治疗进展期胃癌的疗效

目的进展期胃癌患者应用腹腔镜辅助胃癌D2根治术联合胃背侧系膜近胃端完整系膜切除术(complete mesocolic excision,CME)治疗的疗效及安全性。方法进展期胃癌患者98例,随机分为观察组和对照组各49例,观察组行腹腔镜辅助胃癌D2根治术+胃背侧系膜近胃端CME,对照组行腹腔镜辅助胃癌D2根治术,2组术后均采用SOX(奥沙利铂+替吉奥)方案化疗。比较2组手术时间、术中出血量、淋巴结清扫数目、首次排气时间、首次排便时间、下床活动时间、术后住院时间、术后7 d并发症发生率、术后1 a复发率。结果观察组手术时间(131.11±15.46)min]较对照组(150.09±35.47)min]短,术中出血量(58.99±19.14)mL]较对照组(108.99±89.51)mL]少,淋巴结清扫数目(28.07±7.34)个]较对照组(20.49±7.09)个]多(P<0.05);观察组首次排气时间(2.02±0.72)d]、首次排便时间(2.81±0.59)d]、下床活动时间(1.28±0.32)d]均较对照组(2.69±0.62)、(4.35±0.87)、(3.24±0.68)d]早,术后住院时间(6.78±1.88)d]较对照组(9.97±1.74)d]短(P<0.05);观察组术后7 d切口感染、腹胀发生率及总并发症发生率(4.08%、8.16%、20.41%)、术后1 a复发率(6.12%)均低于对照组(20.41%、26.53%、42.86%、24.49%)(P<0.05)。结论腹腔镜辅助胃癌D2根治术联合胃背侧系膜近胃端CME治疗进展期胃癌可缩短手术时间,减少术中出血量,更彻底清扫淋巴结,术后胃肠道功能恢复快、并发症及复发率低。

Laparoscopic D2 radical gastrectomy combined with complete mesocolic excision for advanced gastric cancer

Objective To evaluate the safety and efficacy of laparoscopic D2 radical gastrectomy combined with complete mesocolic excision(CME)in the treatment of advanced gastric cancer.Methods Ninety-eight patients with advanced gastric cancer were randomly divided into observation group and control group,with 49 patients in each group.Observation group received laparoscopic D2 radical gastrectomy+complete mesocolic excision(CME)in the proximal part of the dorsal mesentery,and control group received laparoscopic D2 radical gastrectomy.The operation lasting time,the intraoperative blood loss,the number of lymph node resected,the time of the first exhaust,the time of the first defecation,the time of off-bed activity,the postoperative hospitalization stay,the incidence of complications on the 7 th postoperative day and the recurrence rate in 1 year after operation were compared between two groups.Results Observation group had shorter operation lasting time((131.11±15.46)min),less intraoperative blood loss((58.99±19.14)mL),more lymph node resected(28.07±7.34),earlier first exhaust,first defecation and off-bed activity(((2.02±0.72),(2.81±0.59),(1.28±0.32)d),shorter postoperative hospitalization stay((6.78±1.88)d),lower incidences of incision infection,abdominal distention and total complications(4.08%,8.16%,20.41%),and lower recurrence rate in 1 year after operation(6.12%)than control group(150.09±35.47)min,(108.99±89.51)mL,20.49±7.09,(2.69±0.62)d,(4.35±0.87)d,(3.24±0.68)d,(9.97±1.74)d,20.41%,26.53%,42.86%,24.49%)(P<0.05).Conclusion Laparoscopic D2 radical gastrectomy combined with CME can shorten the operation lasting time,reduce intraoperative blood loss,clean the lymph nodes more thoroughly,recover the gastrointestinal function quickly,and reduce the postoperative complications and recurrence rate.