腹腔镜辅助胃癌根治术的临床疗效  

Clinical efficacy of laparoscopy-assisted radical gastrectomy for gastric cancer

作　　者：杨宏[1] 崔明[1] 邢加迪[1] 张成海[1] 姚震旦[1] 张楠[1] 苏向前[1] 

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所胃肠肿瘤中心四病区恶性肿瘤发病机制及转化研究教育部重点实验室,100142

出　　处：《中华消化外科杂志》2016年第3期234-240,共7页Chinese Journal of Digestive Surgery

基　　金：国家高技术研究发展计划（863计划）（2014AA020603）;国家自然科学基金（81272766）;首都临床特色应用研究（Z121107001012130）;北京市医院管理局临床医学发展专项经费资助（XM201309）

摘　　要：目的探讨腹腔镜辅助胃癌根治术的临床疗效。方法采用回顾性队列研究方法。收集2009年5月至2012年12月北京大学肿瘤医院收治的210例行腹腔镜辅助胃癌根治术患者的临床资料。患者术后病理学分期：Ⅰ期52例，Ⅱ期43例，Ⅲ期115例。根据肿瘤所在的部位和范围选择行腹腔镜辅助根治性远端胃大部切除术、近端胃大部切除术或全胃切除术。观察指标：（1）患者总体治疗情况：手术方式、是否中转开腹、手术时间、术中出血量及输血情况、淋巴结清扫数目；术后肛门排气时间、术后住院时间及术后并发症情况；术后病理学检查肿瘤根治程度。（2）Ⅰ、Ⅱ、Ⅲ期胃癌患者临床病理特征[性别、年龄、BMI、美国麻醉医师协会（ASA）分级、内科合并症、肿瘤部位、肿瘤分化程度、脉管癌栓]；术中及术后情况（手术方式、中转开腹、手术时间、术中出血量、术中输血、淋巴结清扫数目、术后肛门排气时间、术后住院时间、肿瘤根治程度）；术后并发症情况、再次手术、术后30d内死亡情况；术后随访期间患者死亡情况以及3、5年生存率。（3）评价标准：按照美国癌症联合会（AJCC）及国际抗癌协会（UICC）第7版胃癌TNM分期系统对肿瘤进行分期评估和组织学分级。术后并发症严重程度按照Clavien—Dindo分级标准进行划分。采用门诊、电话或邮件形式进行随访，每半年随访1次。随访内容为术后2年内每半年复查腹盆腔CT、胸部x线片和血液检查，每年复查胃镜；术后2～5年每年复查腹盆腔CT、胸部x线片、胃镜和血液检查。随访时间截至2015年12月31日。总生存时间指患者白手术当日至末次随访或因该疾病死亡的时间。正态分布的计量资料以i±S表示，组间比较采用方差分析；偏态分布的计量资料以M（范围）表示，组间比较采用非参数检验。计数资料比较采�Objective To investigate the clinical efficacy of laparoscopy-assisted radical gastrectomy for gastric cancer. Methods The retrospective cohort study was adopted. The clinical data of 210 patients with gastric cancer who underwent laparoscopy-assisted radical gastrectomy at the Peking University Cancer Hospital between May 2009 and December 2012 were collected. Fifty-two, 43 and 115 patients were respectively detected in stage Ⅰ, Ⅱ and Ⅲ of postoperative pathological stage gastrectomies were selectively performed according to the Laparoscopy-assisted radical distal, proximal and total location and extent of tumors. （ 1 ） Overall treatment indicators were observed, including surgical procedure, with or without conversion to open surgery, operation time, volumes of intraoperative blood loss and transfusion, number of lymph node dissected, time to anal exsufflation, duration of hospital stay, occurrence of complications, radical degree of tumors of pathological examination. （2） Other indicators were observed, including pathological features of patients in stage Ⅰ, Ⅱ and Ⅲ [ gender, age, body mass index （ BMI）, scores of American Society of Anesthesiologists （ ASA）, medicinal complication, location of tumors, degree of tumor differentiation and with or without vascular tumor thrombi], intraoperative and postoperative situations （surgical procedure, conversion to open surgery, operation time, volumes of intraoperative blood loss and transfusion, number of lymph node dissected, time to anal exsufflation, duration of hospital stay and radical degree of tumors ）, postoperative complications, reoperation, death within postoperative day 30 and during follow-up, 3- and 5- year survival rates. （ 3 ） Evaluation criteria ： stages and classification of tumors were evaluated according to the tumor node metastasis （TNM） classification of malignant tumours （Seventh Edition） published by American Joint Committee on Cancer （AJCC） and Union for International Cancer Control （UICC�

关 键 词：胃肿瘤 胃切除术 腹腔镜检查 安全性 远期疗效 

分 类 号：R735.2[医药卫生—肿瘤]