改良淋巴结清扫方案在腹腔镜胃癌根治术中的应用效果  

Effect of improved lymph node dissection program applied in laparoscopic radical gastric cancer surgery

作　　者：谢晓东 李峻 Xie Xiaodong;Li Jun(Department of General Surgery,Affiliated Hospital of Nanjing University of Chinese Medicine/Jiangsu Province Hospital of Chinese Medicine,Jiangsu Nanjing 210000,China)

机构地区：[1]南京中医药大学附属医院/江苏省中医院普外科,江苏南京210000

出　　处：《中国医刊》2021年第8期868-872,共5页Chinese Journal of Medicine

基　　金：江苏省中医药局科技项目(YB2017020)。

摘　　要：目的探讨腹腔镜胃癌根治术中实施改良淋巴结清扫方案的临床效果。方法选择2017年1月至2019年6月南京中医药大学附属医院连续收治的76例拟行腹腔镜胃癌根治术的患者,采用随机数字表法分为对照组和观察组,每组38例。对照组在腹腔镜胃癌根治术中采用常规淋巴结清扫方案,观察组采用改良淋巴结清扫方案。比较两组的围术期相关指标、淋巴结清扫情况及术后复发转移情况。结果与对照组相比,观察组术中出血量明显降低(P<0.05),手术时间、术后排气排便时间均明显缩短(P<0.05),但两组手术切口长度、进流质饮食时间、拔除胃管时间及住院时间比较差异无显著性(P>0.05)。两组并发症发生率及严重程度比较差异均无显著性(P>0.05)。观察组脾门区、幽门区、贲门区、腹腔干区淋巴结清扫数及淋巴结清扫总数均高于对照组(P<0.05),随访期间复发转移率低于对照组(P<0.05)。结论腹腔镜胃癌根治术中应用改良淋巴结清扫方案可提高淋巴结清扫效果,缩短手术时间,降低术中出血量,且可能有助于降低复发转移的风险。Objective To explore the clinical effect of improved lymph node dissection applied in laparoscopic radical gastric cancer surgery.Method From March 2017 to June 2019,76 patients with gastric cancer who undergoing laparoscopic radical gastrectomy in our hospital were randomly divided into two groups:38 patients in the control group received routine lymph node dissection,38 patients in the observation group received clockwise modularized lymphadenectomy.The intraoperative and postoperative rehabilitation indicators,complications,lymph node dissections,and recurrence and metastasis between the two groups were compared.Result Compared with the control group,the intraoperative blood loss of observation group was significantly decreased(P<0.05),the operation time,time of first anal exhaust and defecation after surgery of the observation group were significantly shorten(P<0.05).However,there was no significant difference in incision length,time of first liquid diet,extubation time of gastric tube,and hospitalization time between the two groups(P>0.05).There was no significant difference in the incidence and degree of complications between the two groups(P>0.05).Compared with the control group,the number of dissections of the spleen,pylorus,cardia,abdominal trunk and total lymph nodes in the observation group were significantly increased(P<0.05),while the recurrence and metastasis rate was significantly decreased(P<0.05).Conclusion The application of modified lymph node dissection in laparoscopic radical gastric cancer surgery can improve the effect of lymph node dissection,reduce operation time and intraoperative blood loss,and it may help reduce the risk of recurrence and metastasis.

关 键 词：胃癌 腹腔镜 根治性手术 淋巴结清扫 并发症 

分 类 号：R735.2[医药卫生—肿瘤]