保脾脾门淋巴清扫在进展期近端胃癌根治术中的应用价值  

Application value of spleen-preserving splenic hilar lymphadenectomy in radical gastrectomy for advanced proximal gastric cancer

作　　者：范晓峰 陈原华 FAN Xiaofeng;CHEN Yuanhua(General Surgery Department,Renhe Hospital of Baoshan District,Shanghai 200431,China)

机构地区：[1]上海市宝山区仁和医院普外科,上海200431

出　　处：《临床医学研究与实践》2023年第12期35-38,共4页Clinical Research and Practice

摘　　要：目的探讨保脾脾门淋巴清扫在进展期近端胃癌根治术中的应用价值。方法选取2019年6月至2021年12月在我院行进展期近端胃癌根治术的60例患者为研究对象,根据淋巴清扫方式不同将其分为保脾组和切脾组,各30例。保脾组在进展期近端胃癌根治术中给予保脾脾门淋巴清扫治疗,切脾组在进展期近端胃癌根治术中给予切脾脾门淋巴清扫治疗。比较两组的淋巴结转移情况、手术相关指标、并发症发生情况、疼痛情况、免疫功能指标、全血指标、健康状况、肿瘤标志物水平及实验室指标。结果两组的淋巴结转移率、清扫淋巴结数量、淋巴结转移度比较,差异无统计学意义(P>0.05)。保脾组的手术时间短于切脾组(P<0.05);两组的术中出血量、住院时间比较,差异无统计学意义(P>0.05)。两组的并发症总发生率比较,差异无统计学意义(P>0.05)。术后,两组的视觉模拟评分法(VAS)评分均降低(P<0.05);术后,保脾组的VAS评分、白细胞分化抗原8阳性(CD8+)低于切脾组,白细胞分化抗原4阳性(CD4+)、CD4+/CD8+高于切脾组(P<0.05)。术后,两组的白细胞计数(WBC)、中性粒细胞计数(NEUT)、淋巴细胞绝对值(LYM)均降低,卡氏评分(KPS)评分均升高(P<0.05);术后,保脾组的WBC、NEUT、LYM、KPS评分均高于切脾组(P<0.05)。术后,两组的糖类抗原19-9(CA19-9)、糖类抗原72-4(CA72-4)、癌胚抗原(CEA)、肿瘤相关物质(TAM)水平均降低,且保脾组低于切脾组(P<0.05)。术后,两组的P物质(SP)、生长抑素(SS)、神经肽Y(NPY)水平均降低,但保脾组高于切脾组(P<0.05)。结论在进展期近端胃癌根治术中应用保脾脾门淋巴清扫效果较好,可缩短手术时间,减轻疼痛,稳定免疫功能指标及全血指标,改善健康状况,安全可行。Objective To explore the application value of spleen-preserving splenic hilar lymphadenectomy in radical gastrectomy for advanced proximal gastric cancer.Methods A total of 60 patients who underwent radical gastrectomy for advanced proximal gastric cancer in our hospital from June 2019 to December 2021 were selected as the research objects.According to different lymph node dissection methods,the patients were divided into spleen-preserving group and spleen-cutting group,with 30 cases in each group.The spleen-preserving group was treated with spleen-preserving splenic hilar lymphadenectomy during radical gastrectomy for advanced proximal gastric cancer,and the spleen-cutting group was treated with spleen-cutting splenic hilar lymphadenectomy during radical gastrectomy for advanced proximal gastric cancer.The lymph node metastasis,operation-related indexes,occurrence of complications,pain,immune function indexes,whole blood indexes,health status,tumor marker levels and laboratory indexes were compared between the two groups.Results There were no significant differences in lymph node metastasis rate,number of lymph nodes dissected and lymph node metastasis between the two groups(P>0.05).The operation time of the spleen-preserving group was shorter than that of the spleen-cutting group(P<0.05);there were no significant differences in intraoperative blood loss and hospital stay between the two groups(P>0.05).There was no significant difference in the total incidence of complications between the two groups(P>0.05).After operation,the Visual Analogue Score(VAS)score of the two groups decreased(P<0.05);after operation,the VAS score and cluster of differentiation 8 positive(CD8+)in the spleen-preserving group were lower than those in the spleen-cutting group,and the cluster of differentiation 4 positive(CD4+)and CD4+/CD8+were higher than those in the spleen-cutting group(P<0.05).After operation,the white blood cell count(WBC),neutrophil count(NEUT)and lymphocyte absolute value(LYM)of the two groups decreased,and the Karno

关 键 词：保脾 脾门淋巴清扫 进展期近端胃癌根治术 

分 类 号：R735.2[医药卫生—肿瘤]