进展期胃癌保脾手术脾门及脾动脉旁淋巴结清扫的临床意义  

Significance of Preservation of Spleen No.10 and No.11 Lymph Node Dissection in Gastric Cancer Surgery

作　　者：吴启业 伊国恩 张天柱 WU Qi-ye;YI Guo-en;ZHANG Tian-zhu(The first people's Hospital of Xining City,Qinghai Province,Xining 810000)

机构地区：[1]青海省西宁市第一人民医院,青海西宁810000

出　　处：《医学临床研究》2019年第11期2115-2117,共3页Journal of Clinical Research

摘　　要：【目的】探讨胃癌D2根治术中保留脾脏脾门淋巴结(No.10)和脾动脉旁淋巴结(No.11)清扫手术的临床效果及价值。【方法】选取本院手术治疗的进展期胃癌患者66例,根据手术方法分为观察组30例(胃癌D2根治术中保留脾脏的No.10和No.11淋巴结清扫手术)、对照组36例(采用胃癌D2根治术联合脾脏切除手术);对比两组患者的手术时间、手术出血量、住院时间、清扫淋巴结数目、阳性淋巴结检出率、手术并发症率及患者1年和3年生存率。【结果】观察组手术时间长于对照组,手术出血量、住院时间均低于对照组(P<0.05);两组患者清扫淋巴结数目、阳性淋巴结检出率比较,差异无统计学意义(P>0.05)。观察组手术并发症发生率为13.33%(4/30)低于对照组的30.56%(11/36),差异有统计学意义(χ^2=4.44,P<0.05)。对两组患者进行3年随访,观察组和对照组失访率比较,差异无统计学意义(P>0.05);观察组患者1年、3年生存率与对照组比较,差异无统计学意义(P>0.05)。观察组3年生存中位生存时间为32.0个月与对照组的29.0个月比较差异无统计学意义(P>0.05)。【结论】胃癌D2根治术中保留脾脏的No.10和No.11淋巴结清扫手术具有与脾脏切除术相似临床效果及预后,且手术并发症率更低、手术创伤更小。【Objective】To explore the clinical effect and value of splenomegaly lymph node(No.10)and paraarterial lymph node(No.11)preserved in D2 radical gastrectomy.【Methods】Sixty-six patients with advanced gastric cancer were divided into observation group(30 cases,lymph node dissection with spleen No.10 and No.11 preserved in D2 radical gastrectomy)and control group(36 cases,D2 radical gastrectomy combined with splenectomy for gastric cancer)according to the operation method.The operation time,bleeding volume,hospitalization time,number of lymph nodes,positive lymph node detection rate,operation complication rate and 1-year and 3-year survival rate were compared between the two groups.【Results】The operation time of the observation group was longer than that of the control group,and the bleeding volume and hospitalization time of the operation were lower than those of the control group(P<0.05).There was no significant difference between the two groups in the number of lymph nodes cleaned and the detection rate of positive lymph nodes(P>0.05).The incidence of surgical complications in the observation group was 13.33%(4/30)lower than that in the control group(30.56%11/36).The difference was statistically significant(χ^2=4.44,P<0.05).There was no significant difference between the observation group and the control group(P>0.05);there was no significant difference between the observation group and the control group(P>0.05).The median 3-year survival time was 32.0 months in the observation group and 29.0 months in the control group,there was no significant difference(P>0.05).【Conclusion】Lymph node dissection with spleen No.10 and No.11 preserved in D2 radical gastrectomy have similar clinical effect and prognosis with splenectomy,and have lower complication rate and less trauma.

关 键 词：胃肿瘤/外科学 淋巴结切除术 

分 类 号：R735.2[医药卫生—肿瘤]