胃中上部癌腹腔镜脾门淋巴结清扫效果及安全性评价  

Therapeutic efficacy and safety evaluation of laparoscopic-assisted splenic hilar lymph nodes dissection in middle-proximal gastric carcinoma

作　　者：钱昆[1] 毛冰朗[2] 张伟[1] 黎晖[1] 王子卫[1] 

机构地区：[1]重庆医科大学附属第一医院胃肠外科,400016 [2]重庆医科大学附属第一医院体检中心,400016

出　　处：《腹部外科》2013年第4期241-243,共3页Journal of Abdominal Surgery

摘　　要：目的 评价胃中上部癌腹腔镜脾门淋巴结清扫效果及安全性.方法 2012年1月至12月所有行胃中上部癌根治性切除患者64例的临床资料,其中开腹组21例,腹腔镜组43例.结果 开腹近端胃癌根治术与腹腔镜近端胃癌根治术清扫淋巴结个数两组间没有显著性差异.比较两种术式脾门淋巴结（第10组＋第11组）清扫效果,在近端胃癌根治术、全胃切除胃癌根治术、和全体中上部癌中腹腔镜手术清扫的脾门淋巴结均多于开腹手术组,分别为近端胃（4.50±0.66）个和（1.63±0.57）个,全胃（4.24±0.43）个和（2.54±0.50）个,总体（4.33±0.36）个和（2.19±0.38）个,差异均有统计学意义.无论近端胃胃癌根治术还是全胃切除胃癌根治术还是总体上,腹腔镜清扫的阳性脾门淋巴结（第10组＋第11组）数量均比开腹多,但差距很小,差异没有统计学意义.比较两种术式脾门淋巴结阳性患者比例,腹腔镜并没有增加阳性脾门淋巴结（第10组＋第11组）患者的检出比例两组也没有差异.熟练的腹腔镜胃癌根治术加脾门淋巴结清扫术手术时间比开腹大为缩短（184.00±9.76）min和（263.00±22.26）min（P=0.0003）,手术出血量也减少,（120.00±7.63）ml和（170.00±13.31）ml（P=0.0009）.23例开腹手术中因为脾门出血行脾脏切除4例,而在腹腔镜组只要1例（P=0.0193）.术后出血、感染、瘘、围手术期死亡等严重手术并发症在腹腔镜组未见显著增加.结论 腹腔镜胃癌根治术在脾门淋巴结清扫方面比开腹具备优势,其清扫数量高于开腹,但其远期效果仍待进一步研究.腹腔镜胃癌根治术加脾门淋巴结清扫比开腹手术时间缩短,出血量也较少,而且是安全的,值得进一步的推广.Objective To investigate therapeutic efficacy and safety evaluation of laparoscopicassisted splenic hilar lymph nodes dissection in middle-proximal gastric carcinoma. Methods From January 2012 to December 2012, total 64 cases with middle-proximal gastric carcinoma underwent surgery in our center, in which 21 of them underwent open surgery and 43 underwent laparoscopic surgery. Results Between two groups, the number of splenic hilar lymph nodes dissected presented no statistic differences. We further compared the dissection efficacy for splenic hilar lymph nodes. In laparoscopic-assisted dissection, the dissected nodes number in proximal gastrectomy procedure （4. 50 ± 0. 66 and 1.63 ±0. 57）, radical gastrectomy procedure （4. 24 ± 0. 43）, and middle-proximal gastrectomy procedure （4. 33±0. 36 and 2. 19±0. 38）, present significantly better efficacy in contrast to traditional open surgery. Positive splenic hilar lymph nodes dissection number in both proximal gastrectomy pro- cedure and radical gastrectomy procedure in ｜aparoscopic surgery, were more than open surgery, but instead of statistic difference and positive examination rate. Furthermore, we suggested that better proficiency in laparoscopy would greatly reduce the operating time （Lap vs. open = 184. 00 ± 9. 76 min vs. 263. 00 ± 22. 26 min, P = 0. 0003） and bleeding volume （Lap vs. open = 120. 00 ± 7. 63 ml vs. 170. 00± 13. 31 ml, P = 0. 0009）. Meanwhile, the complication rate would also found to be decreased significantly. Conclusion Laparoscopic-assisted splenic hilar lymph nodes dissection in middle-proximal gastric carcinoma presents better efficacy than traditional open surgery. It is helpful in reduction of operation time, bleeding volume and is also safety procedure. The long term of follow up study is still needed for further evaluation of efficacy.

关 键 词：腹腔镜 胃肿瘤 淋巴结 

分 类 号：R735.2[医药卫生—肿瘤]