十二指肠离断时机对腹腔镜辅助远端胃癌根治术近期临床疗效影响的多中心回顾性研究（附239例报告）  

Short-term clinical effects of selecting duodenal transection timing on laparoscopic.assisted distal gastrectomy： a multicentre retrospective study （A report of 239 cases ）

作　　者：林和新 陈锦萍[3] 苏国强[1] 张国伟 傅锦波[5] 叶志坚[5] 卢传辉[1] 龚江 黄荣杰 柯海林 蔡丽生 尤俊[1] Lin Hexin;Chen Jinping;Su Guoqiang;Zhang Guowei;Fu Jinbo;Ye Zhijian;Lu Chuanhui;Gong Jiang;Huang Rongjie;Ke Hailin;Cai Lisheng;You Jun.(Department of Gastrointestinal Oneology Surgery, Xiamen Ontology Hospital, the First Affiliated Hospital of Xiamen Uaiversity, School of Clinical Medicine Fujian Medical University, Xiamen 361003, China)

机构地区：[1]厦门大学附属第一医院厦门市肿瘤医院福建医科大学临床医学部胃肠肿瘤外科,361003 [2]福建医科大学附属漳州市医院普外四科,363000 [3]福建医科大学附属泉州第一医院普通外科,362002 [4]厦门医学院附属第二医院胃肠外科,361022 [5]厦门大学附属中山医院普通外科、胃肠外科,361003

出　　处：《中华消化外科杂志》2018年第6期571-580,共10页Chinese Journal of Digestive Surgery

基　　金：吴阶平医学基金会临床科研专项（320-6750-17509）

摘　　要：目的：探讨十二指肠离断时机对腹腔镜辅助远端胃癌根治术近期临床疗效的影响。方法：采用回顾性队列研究方法。收集2016年3月至2018年3月国内5家医疗中心收治的239例（厦门大学附属第一医院104例、福建医科大学附属漳州市医院45例、福建医科大学附属泉州第一医院35例、厦门医学院附属第二医院30例、厦门大学附属中山医院25例）行腹腔镜辅助远端胃癌根治术患者的临床病理资料。239例患者均行腹腔镜辅助远端胃癌与D2淋巴结清扫术，其中107例（厦门大学附属第一医院64例、福建医科大学附属漳州市医院8例、福建医科大学附属泉州第一医院16例、厦门医学院附属第二医院 14例、厦门大学附属中山医院5例）患者淋巴结清扫过程中完成幽门下区淋巴结清扫后，先离断十二指肠再清扫胰腺上区淋巴结，设为前入路组；132例（厦门大学附属第一医院40例、福建医科大学附属漳州市医院37例、福建医科大学附属泉州第一医院19例、厦门医学院附属第二医院16例、厦门大学附属中山医院20例）患者先清扫胰腺上区淋巴结再离断十二指肠，设为后入路组。观察指标：（1）手术及术后情况。（2）术后并发症情况。（3）术后不同TNM分期、体质量指数（BMI）、肿瘤最大径患者手术及术后情况的分层分析。（4）随访和生存情况。采用门诊和电话方式进行随访，了解患者术后总体生存、肿瘤复发、肿瘤转移情况。随访时间截至2018年4月。正态分布的计量资料以±s表示，组间比较采用独立样本t检验。偏态分布的计量资料以M（Q）表示，组间比较采用非参数检验。计数资料比较采用x2检验或Fisher确切概率法。等级资料比较采用秩和检验。结果：（1）手术及术后情况：239例患者均顺利完成手术，无围术期 死亡。前入路组与后入路组患者幽门上区淋巴结清扫数Objective：To investigate the shortterm clinical effects of selecting duodenal transection timing on laparoscopicassisted distal gastrectomy （LADG）. Methods：The retrospective cohort study was conducted. The clinicopathological data of 239 gastric cancer （GC） patients undergoing LADG in the 5 medical centers between March 2016 and March 2018 were collected, including 104 in the First Affiliated Hospital of Xiamen University, 45 in Zhangzhou Affiliated Hospital of Fujian Medical University, 35 in Quanzhou Affiliated Hospital of Fujian Medical University, 30 in the Second Affiliated Hospital of Xiamen Medical College, 25 in Zhongshan Hospital of Xiamen University. Of 239 patients undergoing LADG ＋ D2 lymph node dissection, 107 receiving duodenal transection and then lymph node dissection in the upper region of pancreas after lymph node dissection in the lower region of pylorus and 132 receiving lymph node dissection in the upper region of pancreas and then duodenal transection were respectively divided into anterior approach group and posterior approach group. Sixtyfour, 8, 16, 14 and 5 patients in the anterior approach group and 40, 37, 19, 16 and 20 patients in the posterior group respectively came from the First Affiliated Hospital of Xiamen University, Zhangzhou Affiliated Hospital of Fujian Medical University, Quanzhou Affiliated Hospital of Fujian Medical University, Second Affiliated Hospital of Xiamen Medical College and Zhongshan Hospital of Xiamen University. Observation indicators： （1） surgical and postoperative situations; （2） postoperative complications; （3） stratified analyses of surgical and postoperative situations in patients with different TNM staging, body mass index （BMI） and maximum tumor dimension; （4） followup and survival. Followup using outpatient examination and telephone interview was performed to detect postoperative overall survival and tumor recurrence or metastasis up to April 2018. Measurement data with normal distribution were represented as ±s, an

关 键 词：胃肿瘤 远端 根治术 十二指肠离断时机 手术入路 腹腔镜检查 多中心 回顾性研究 

分 类 号：R735.2[医药卫生—肿瘤]