进展期胃癌根治术两种淋巴结清扫方法的效率及其特点  

Efficiency and feature of two approaches of lymph node dissection for advanced gastric cancer

作　　者：陈晓鹏[1] 王东[1] 王冠男[1] 杨来志[1] 葛国朝[1] 张卫东[1] 张国政[2] 张帆[3] 

机构地区：[1]皖南医学院弋矶山医院普外科,安徽芜湖241001 [2]皖南医学院弋矶山医院消化内科,安徽芜湖241001 [3]皖南医学院弋矶山医院病理科,安徽芜湖241001

出　　处：《中国现代医学杂志》2011年第24期3063-3066,共4页China Journal of Modern Medicine

基　　金：安徽省卫生厅临床医学重点学科基金项目(No:05A016)

摘　　要：目的比较进展期胃癌根治术中传统解剖法和刮吸解剖法淋巴结清扫的效率,并分析其特点。方法 62例进展期胃癌随机分为传统手术组(n=31)和刮吸手术组(n=31),前者采用传统手术器械进行淋巴结清扫,后者采用多功能手术解剖器刮吸法清扫;分别统计两组手术方式、手术时间、出血量、输血量、清除淋巴结数、术后肿瘤复发率和生存率。结果传统手术组和刮吸手术组平均手术时间分别为(208±48.3)和(218±67.2)min(P>0.05);术中平均出血量分别为(309.4±121.8)和(248.4±116.3)mL(P<0.05);术中输血分别有11例和14例,输血者平均输血量分别为(745.5±237.4)和(457.1±159.2)mL(P<0.05)。两组平均清除淋巴结分别为(14.1±6.7)和(21.5±9.3)枚(P<0.05),平均清除阳性淋巴结分别为(4.9±2.1)和(6.8±2.7)枚(P<0.05)。两组分别有25和26例得到平均5年的随访,肿瘤复发率分别为52.0%(13/25)和23.1%(6/26()P<0.05),生存率分别为40.0%(10/25)和69.2%(18/26()P<0.05)。结论与传统解剖法相比,刮吸解剖法可提高进展期胃癌淋巴结清扫程度和清扫效率,减少术中出血量和输血量;并降低肿瘤复发率,延长患者生存时间。其淋巴结清扫效率差异可能与所用手术解剖器械结构特点有关。【Objective】 To compare the efficiency of the conventional dissection and curettage-aspiration dissection in lymph node dissection for advanced gastric cancer,and analyses their features.【Methods】 62 patients with advanced gastric cancer were randomly divided into the conventional surgery group（CS group,n=31） and the curettage-aspiration surgery group（CA group,n =31）.The procedures were finished with common surgical instruments in the CS group and Peng＇s multifunction operative dissector（PMOD） in the CA group.The operation time,intraoperative hemorrhage quantity,blood transfusion amount,the number of cleared lymph node and postoperative data of follow-up were collected.【Results】 The average surgery time were（208±48.3） min in CS group and（218±67.2） min in CA group（P 0.05）,respectively.The average intraoperative hemorrhage quantity were（309.4±121.8） and（248.4±116.3） mL（P 0.05）,respectively.There were 11 and 14 patients who accepted blood transfusion during operation with the average blood transfusion amount（745.5±237.4） and（457.1±159.2） mL（P 0.05）,respectively.The average numbers of cleared lymph node was（14.1±6.7） and（21.5±9.3） with positive lymph node（4.9±2.1） and（6.8±2.7）,respectively.During the 5 years of follow-up time,the tumor recurrence rates in CS group and CA group were 52.0%（13/25） and 23.1%（6/26）（P 0.05）,respectively,and survival rates were 40.0%（10/25） and 69.2%（18/26）（P 0.05）,respectively.【Conclusion】 Compared with the conventional surgery,curettage-aspiration dissection may improve the efficiency of lymph node dissection for advanced gastric cancer,reduce the hemorrhage quantity,decrease the tumor recurrence rate and lengthen the live time of patients.The efficiency variance of lymph node dissection between two groups may be concerned with the construction features of used dissecting instrument.

关 键 词：刮吸解剖法 胃癌 根治术 淋巴结清扫术 

分 类 号：R735.2[医药卫生—肿瘤]