腹腔镜下不同手术入路对胃上部癌行脾门淋巴结清扫的疗效分析  

The analysis of different surgical approaches for laparoscopic splenic hilar lymph node dissection for upper gastric cancer

作　　者：李恩[1] 吴祖光[1] 李志旺[1] 

机构地区：[1]梅州市人民医院胃肠外一科,广东梅州514031

出　　处：《消化肿瘤杂志（电子版）》2015年第4期209-212,共4页Journal of Digestive Oncology(Electronic Version)

摘　　要：目的探讨腹腔镜下胃上部癌脾门淋巴结清扫的合理手术入路及临床疗效。方法选取本院2013年1月至2015年7月确诊胃上部癌患者78例,采用简单随机化分组的方法将患者分为三组,行腹腔镜下胃癌根治,经不同手术入路行脾门淋巴结清扫。A组29例,采用左侧入路法,B组26例,采用胰后入路法,C组23例,采用右侧入路法。针对三组患者的脾门淋巴结清扫手术时间、术中出血量、清扫脾门淋巴结数目、恢复排气时间、并发症发生率等因素进行统计学分析。结果三组患者在年龄、性别、术后病理分期方面比较,差异无统计学意义(均P>0.05)。三组患者在手术时间、术后恢复排气时间及并发症发生率方面比较,差异均无统计学意义(均P>0.05)。A组患者术中出血量[(37.2±20.7)ml]明显少于B组[(54.5±17.8)ml]和C组[(45.6±25.5)ml](F=3.750,P=0.024)。A组脾门淋巴结清扫数目[(4.6±2.3)枚]均明显高于B组[(3.2±2.6)枚]和C组[(2.8±1.7)枚](F=8.543,P=0.001)。结论左侧入路法是腹腔镜下脾门淋巴结清扫有效、安全的手术入路,更有利于初学者对脾门淋巴结清扫技术的掌握,值得临床推广。Objective To investigate the proper surgical approach and clinical efficacy of laparoscopic splenic hilar lymph node dissection in upper gastric cancer patients. Methods Seventy-eight cases with upper gastric cancer were randomly divided into three groups according to different surgical approaches, and received laparoscopic radical resection and splenic hilar lymph node dissection. Splenic hilar lymph node dissection was performed in group A with left approach, group B with retropancreatic approach, and group C with right approach. The operative time, intraoperative blood loss, number of lymph nodes dissected, recovery anal exhaust time and complication rate were compared among the three groups. Results There were no significant differences in age, gender, and postoperative TNM stage, as well as operative time, anal exhaust time and postoperative complication rate among the three groups （all P〉0.05）. The volume of intraoperative blood loss in group A （37.2±0.7 ml） were less than group B （54.5±17.8 ml） and group C （45.6±25.5 ml）（F=3.750,P=0.024）. The number of lymph nodes dissected in group A （4.6±2.3） were significantly better than goup B （3.2±2.6） and group C （2.8±1.7） （F=8.543,P=0.001）. Conclusions The left approach is an effective and safe surgical approach in laparoscopic splenic hilar lymph node dissection which is more suitable for beginners to master laparoscopic. Laparoscopic splenic hilar lymph node dissection with left approach is worth to be popularized in clinic.

关 键 词：胃上部癌 腹腔镜 脾门淋巴结清扫 手术入路 

分 类 号：R735.2[医药卫生—肿瘤]