腹腔镜辅助远端胃癌D2根治术治疗胃癌的疗效观察  

Efficacy of laparoscopy-assisted D2 radical distal gastrectomy for gastric cancer

作　　者：许全林 许超 崔琼[3] XU Quan-lin;XU Chao;CUI Qiong(Department of General Surgery,Xi'an Third Hospital,Xi'an 710016,China;Department of General Surgery,Linyou County Traditional Chinese Medicine Hospital,Linyou 721500,China;Department of General Surgery,Yan'an University Affiliated Hospital,Yan'an 716000,China)

机构地区：[1]西安市第三医院普外科,西安710016 [2]麟游县中医医院普外科,麟游721500 [3]延安大学附属医院普外科,延安716000

出　　处：《中国肿瘤临床与康复》2020年第10期1220-1223,共4页Chinese Journal of Clinical Oncology and Rehabilitation

基　　金：陕西省社会发展科技攻关项目(2019SF-222)。

摘　　要：目的探讨腹腔镜辅助远端胃癌D2根治术治疗胃癌的临床效果。方法选取2018年1月至2019年1月间西安市第三医院收治的110例胃癌患者,根据治疗方案不同分为观察组60例和对照组50例。观察组患者采用腹腔镜辅助远端胃癌D2根治术治疗,对照组患者采用开腹远端胃癌D2根治术治疗,比较两组患者手术情况、并发症和1年生存率,检测糖类抗原72-4(CA72-4)和细胞角蛋白19片段(CYFRA21-1)水平。结果观察组患者手术时间长于对照组,术中出血量和术后肛门排气时间均少于对照组,差异均有统计学意义(均P<0.05)。术后,两组患者CA72-4和CYFRA21-1水平均较术前降低,且观察组均低于对照组,差异均有统计学意义(均P<0.05)。观察组患者发生切口感染1例,吻合口瘘2例,并发症发生率为5.0%;对照组患者发生切口感染3例,吻合口出血3例,吻合口瘘4例,并发症发生率为20.0%,两组比较,差异有统计学意义(2=5.89,P<0.05)。术后随访1年,观察组患者1年存活率为93.3%(56例),对照组为96.0%(48例),两组比较,差异无统计学意义(2=0.04,P>0.05)。结论腹腔镜辅助远端胃癌D2根治术治疗胃癌效果较好,可降低血清CA72-4和CYFRA21-1水平。Objective To investigate the clinical efficacy of laparoscopy-assisted D2 radical distal gastrectomy for gastric cancer.Methods One hundred patients with gastric cancer treated at Xi'an Third Hospital from January 2018 to January 2019 were selected.According to the treatment plan,the patients were divided into an observation group(60 patients)and a control group(50 patients).The observation group was treated with laparoscopy-assisted D2 radical distal gastrectomy and the control group was treated with open D2 radical distal gastrectomy.The operation,complications and 1-year survival rate were compared between the two groups,and the levels of carbohydrate antigen 72-4(CA72-4)and cytokeratin 21-1(CYFRA21-1)were measured before and after operation.Results The operation duration was longer in the observation group than in the control group(P<0.05),while the amount of haemorrhagia and time to anal exhaust were significantly less in the observation group than in the control group(all P<0.05).The levels of CA72-4 and CYFRA21-1 decreased in both groups after the surgery with the levels lower in the ob-servation group than in the control group(all P<0.05).Wound infection occurred in 1 patient and anastomosis fistula occurred in 2 patients in the observation group and the incidence of complications was 5.0%.Wound infection occurred in 3 patients,anastomotic bleeding occurred in 3 patients and anastomosis fistula occurred in 4 patients in the control group with significant differences between the two groups(all P<0.05).After a 1-year follow-up,the survival rate was 93.3%(56 patients)in the observation group and 96.0%in the control group(P<0.05).Conclusion Laparoscopy-assisted D2 radical distal gastrectomy shows good efficacy in the treatment of gastric cancer,which can significantly reduce the levels of serum CA72-4 and CYFRA21-1.

关 键 词：腹腔镜辅助远端胃癌D2根治术 胃肿瘤 糖类抗原72-4 细胞角蛋白19片段 

分 类 号：R735.2[医药卫生—肿瘤]