摘要
目的探讨腹腔镜D2全胃切除术与全胃系膜切除术(CME)对进展期胃癌的可行性、安全性。方法收集2015年1月至2020年1月上海交通大学医学院附属仁济医院南院收治的进展期胃癌患者300例,其中行标准D2全胃切除术150例(D2组),D2组基础上给予CME治疗的患者150例(D2+CME组)。比较两组患者手术时间、术后出血量、淋巴结清扫数量等相关手术指标,记录统计两组患者首次下床活动时间、术后排气时间、住院时间及半流质饮食时间等术后恢复指标,同时比较两组患者术后并发症及随访2年期间复发与死亡情况。结果两组患者手术时间、术中出血量差异无统计学意义,D2+CME组患者淋巴结清扫个数显著高于D2组,胃系膜未完整切除率则显著低于D2组(P<0.05)。两组患者住院时间、术后排气时间、半流质饮食时间及下床活动时间差异无统计学意义;D2+CME组患者术后并发症发生率、复发率及病死率明显低于D2组(P<0.05)。结论腹腔镜D2全胃切除术联合CME对进展期胃癌具有良好的治疗效果且预后良好,作为一项安全有效的术式,值得在临床推广使用。
Objective To explore the feasibility and safety of laparoscopic D2 total gastrectomy and complete mesenteric resection(CME)for advanced gastric cancer.Methods From January 2015 to January 2020,three hundred patients with advanced gastric cancer admitted to the South Hospital of Renji Hospital Affiliated to Medical College of Shanghai Jiaotong University were collected.One hundred and fifty patients underwent standard D2 total gastrectomy(D2 group),and the other 150 patients received CME treatment on the basis of D2 group(D2+CME group).The operation time,blood loss and lymph node dissection were compared between the two groups,and the postoperative recovery indexes such as hospitalization time,postoperative exhaust time,semi-liquid diet time and the bed-off time were recorded.The incidence of postoperative complications,recurrence and mortality of the two groups were compared.Results There were no significant differences in operation time,blood loss,hospital stay,postoperative exhaust time,semiliquid diet time and bed-off time between the two groups.Compared with D2 group,the number of lymph node dissection in D2+CME group was significantly higher,and the rate of incomplete mesenteric resection was significantly lower(P<0.05).The incidence of postoperative complications,recurrence rate and mortality in D2+CME group were significantly lower than those in D2 group(P<0.05).Conclusions Laparoscopic D2 total gastrectomy combined with CME has a good therapeutic effect on advanced gastric cancer,and the prognosis of patients is good.As a safe and effective operation,it is worthy of clinical application.
作者
张捷
陈渊文
邱伟箐
朱宏毅
钱昌林
沈志勇
沈火剑
Zhang Jie;Chen Yuanwen;Qiu Weijing;Zhu Hongyi;Qian Changlin;Shen Zhiyong;Shen Huojian(Department of General Surgery,South Hospital of Shanghai Renji Hospital Affiliated to Medical College of Shanghai Jiaotong University,Shanghai 201114,China)
出处
《中华普通外科学文献（电子版）》
CAS
2021年第2期91-94,共4页
Chinese Archives of General Surgery(Electronic Edition)
基金
上海市卫生健康委员会科研项目(201940433)。
关键词
胃切除术
腹腔镜
胃肿瘤
全胃系膜切除术
Gastrectomy
Laparoscopes
Stomach neoplasms
Complete mesomectomy
