不同TNM分期胃癌患者的微创手术效果研究  

Minimally Invasive Surgery for Different TNM Stages of Gastric Cancer

作　　者：苏晓文[1] 邓建中[1] 梁伟成[1] SU Xiao-wen;DENG Jian-zhong;LIANG Wei-cheng(Department of Surgery,Gaozhou People’s Hospital,Gaozhou 525200,China)

机构地区：[1]高州市人民医院外科,广东高州525200

出　　处：《南昌大学学报（医学版）》2018年第1期65-68,80,共5页Journal of Nanchang University：Medical Sciences

摘　　要：目的探讨不同TNM分期胃癌患者的微创手术效果。方法选取2010年1月至2012年12月高州市人民医院外科收治的185例行腹腔镜胃癌根治术患者为研究对象,根据TNM分期分为Ⅰ期组(n=46)、Ⅱ期组(n=38)、Ⅲ期组(n=101),比较3组的基线资料、肿瘤相关资料、术中、术后资料及随访结果。结果 3组的肿瘤位置与手术方式比较,差异均有统计学意义(P<0.05)。Ⅲ期组中低分化的比例为79.2%,显著高于Ⅰ期、Ⅱ期组的41.3%、47.4%,差异有统计学意义(P<0.05)。随着TNM分期的升高,脉管癌栓的阳性率逐渐升高(P<0.05)。Ⅰ期组无一例术中输血,该比例显著低于Ⅱ期、Ⅲ期组的15.8%、10.9%,差异有统计学意义(P<0.05)。Ⅰ期组淋巴结清扫数目显著低于Ⅲ期组,差异有统计学意义(P<0.05)。3组的手术时间、术中失血率、中转开腹率、术后首次排气时间、恢复流质进食时间、术后住院天数、并发症发生率及严重程度、再次手术率比较,差异均无统计学意义(P>0.05)。Ⅰ期、Ⅱ期、Ⅲ期胃癌患者术后3年的生存率(OS)分别为95.3%、85.9%、60.8%,5年OS分别为91.1%、75.8%、53.8%,三者相比差异有统计学意义(P<0.001)。结论不同TNM分期胃癌患者行腹腔镜根治术的安全性类似,近、远期疗效令人满意。Objective To investigate the efficacies of minimally invasive surgery in different TNM stages of gastric cancer.Methods According to the TNM staging of gastric cancer,185 patients who underwent laparoscopy-assisted gastrectomy from January 2010 to December 2012 in our hospital were divided into three groups:stageⅠ(n=46),stageⅡ(n=38)and stageⅢ(n=101).The baseline,tumor-related,intraoperative and postoperative data and the follow-up results were compared among the three groups.Results There were significant differences in tumor location and surgical procedures among the three groups(P<0.05).The proportion of patients with moderate and poor differentiation in stageⅢgroup(79.2%)was higher than that in stageⅠgroup(41.3%)and that in stageⅡgroup(47.4%)(P<0.05).The positive rate of vascular tumor thrombus increased with advanced TNM stage(P<0.05).The proportion of patients receiving intraoperative blood transfusion in stageⅠgroup(0%)was lower than that in stageⅡgroup(15.8%)and that in stageⅢgroup(10.9%)(P<0.05).The number of lymph nodes dissected in stageⅠgroup was lower than that in stageⅢgroup(P<0.05).There were no significant differences in operation time,intraoperative blood loss,time to first flatus,time to fluid intake,length of postoperative hospital stay,incidence and severity of complications,and rate of reoperation among the three groups(P>0.05).Postoperative 3-and 5-year overall survival rates were,respectively,95.3%and 91.1%in stageⅠgroup,85.9%and 75.8%in stageⅡgroup,and 60.8%and 53.8%in stageⅢgroup.The differences were significant among the three groups(P<0.001).Conclusion Laparoscopy-assisted gastrectomy is safe and satisfactory for different TNM stages of gastric cancer.

关 键 词：腹腔镜手术 临床分期 胃癌 安全性 疗效 

分 类 号：R735.2[医药卫生—肿瘤]