腹腔镜全胃联合胰体尾脾切除术治疗T4b期胃癌的可行性、安全性和远期疗效  

Feasibility,safety and long-term efficacy of laparoscopic total gastrectomy combined with distal pancreaticosplenectomy for T4b gastric cancer

作　　者：周声宁 杨斌[1] 谭嘉男 黄静 陈志涛[1] 郑森友 高涵 张育超[1] 温立强[1] 韩方海[1] Zhou Shengning;Yang Bin;Tan Jianan;Huang Jing;Chen Zhitao;Zheng Senyou;Gao Han;Zhang Yuchao;Wen Liqiang;Han Fanghai(Department of Gastrointestinal Surgery,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China)

机构地区：[1]中山大学孙逸仙纪念医院胃肠外科,广州510120

出　　处：《中华胃肠外科杂志》2020年第2期163-169,共7页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金面上项目(81572925)。

摘　　要：目的探讨腹腔镜全胃联合胰体尾脾切除术治疗T4b期胃癌的可行性、安全性和远期疗效。方法采用回顾性队列研究的方法。回顾性分析中山大学孙逸仙纪念医院胃肠外科2010年1月至2014年12月期间连续收治的侵犯胰体尾部原发性T4b期胃癌并行腹腔镜或开放根治性全胃联合胰体尾脾切除术患者的临床资料。病例入组标准:(1)原发性胃癌,病理活检确诊为T4b期腺癌;(2)胸部+腹部+盆腔增强CT提示肿瘤侵犯胰体尾部,未见远处转移病灶,术前评估潜在R0切除可能;(3)体力状态美国东部肿瘤协作组评分(ECOG)0~2分,身体一般状况可耐受手术。排除术中发现腹膜种植转移和肿瘤侵犯其他器官、或因其他原因改变手术方式者。所有手术均由同一外科团队完成,手术团队已有超过100例腹腔镜和100例开放胃癌根治术加D2淋巴结清扫术的经验。手术方式的选择由手术医师与患者共同讨论并根据患者本人意愿决定。根据手术方式将患者分为腹腔镜手术组和开放手术组,对比分析两组患者手术和围手术期情况;采用Kaplan-Meier法绘制生存曲线,采用log-rank检验进行3年无病生存率的比较。结果共纳入37例患者,腹腔镜手术组21例,开放手术组16例,无腹腔镜中转开腹手术病例。两组患者临床基线资料具有可比性(均P>0.05)。腹腔镜手术组较开放手术组手术时间长[(264.0±35.1)min比(226.6±49.9)min,t=2.685,P=0.011],术中失血少[(65.7±37.4)ml比(182.2±94.6)ml,t=-4.658,P<0.001],术后肛门排气时间缩短[(2.8±0.7)d比(4.1±0.7)d,t=-5.776,P<0.001],术后住院天数短[(13.3±2.8)d比(16.6±4.3)d,t=-2.822,P=0.008]。腹腔镜手术组与开放手术组术后并发症(包括吻合口漏、胰漏、腹腔脓肿、腹腔内出血和十二指肠残端漏)发生率分别为19.0%(4/21)和4/16,差异无统计学意义(P=0.705)。无术后吻合口出血、吻合口狭窄病例。腹腔镜手术组和开放手术组术后30 d病Objective To explore the feasibility,safety and long-term efficacy of laparoscopic total gastrectomy combined with distal pancreaticosplenectomy for the treatment of T4b gastric cancer.Methods A retrospective cohort study was performed.Clinical data of consecutive patients with T4b gastric cancer invading pancreatic tail undergoing laparoscopic or open total gastrectomy combined with distal pancreaticosplenectomy from January 2010 to December 2014 were analyzed retrospectively.Enrollment criteria:(1)primary gastric cancer confirmed by pathology as T4b adenocarcinoma;(2)chest+abdominal+pelvic enhanced CT indicated cancer invading pancreatic tail without distant metastasis,and R0 resection was evaluated as feasible before operation;(3)physical status was ECOG score 0 to 2,and was tolerant to operation.Patients with peritoneal implant metastasis and tumor invasion of other organs during operation,or changes in surgical methods for other reasons were excluded.All the operations were performed by the same surgical team,which had the experiences of more than 100 cases of laparoscopic and 100 cases of open radical gastrectomy with D2 lymph node dissection.The choice of surgical procedure was discussed by the surgeon and the patient,and decided according to the patient′s intension.Patients were divided into the laparoscopic group and open group according to the surgical method.Intraoperative and perioperative findings were compared between the two groups.The 3-year disease-free survival rate were analyzed with Kaplan-Meier survival curve and compared by using log-rank test.Results A total of 37 consecutive patients were enrolled,including 21 in the laparoscopic group and 16 in the open group,and no one receiving laparoscopic procedure was converted to open surgery.The baseline data of two groups were comparable(all P>0.05).Compared with the open group,the laparoscopic group had significantly longer operation time[(264.0±35.1)minutes vs.(226.6±49.9)minutes,t=2.685,P=0.011],significantly less intraoperative blood loss[

关 键 词：胃肿瘤 肿瘤分期 T4b 全胃切除术 腹腔镜 胰体尾脾切除术 

分 类 号：R735[医药卫生—肿瘤]