拓展胃后间隙在全腹腔镜近端胃癌根治术中的应用  

Application of pre-expansion of posterior gastric space in laparoscopic radical proximal gastrectomy

作　　者：李雷 马家驰[2] 张晨嵩 陈玉忠 杜军 王庆康 符炜 LI Lei;MA Jiachi;ZHANG Chensong;CHEN Yuzhong;DU Jun;WANG Qingkang;FU Wei(The Graduate School of Xuzhou Medical University,Xuzhou,Jiangsu 221000,China;Department of Oncological Surgery,the First Affiliated Hospital of Bengbu Medical College,Bengbu,Anhui 233000,China)

机构地区：[1]徐州医科大学研究生院,江苏徐州221000 [2]蚌埠医学院第一附属医院肿瘤外科,安徽蚌埠233000

出　　处：《中国普通外科杂志》2023年第4期575-582,共8页China Journal of General Surgery

基　　金：安徽省自然科学基金资助项目(2208085MH242);蚌埠医学院自然科学创新团队基金资助项目(BYKC201907)。

摘　　要：背景与目的:近端胃癌根治术中,在处理胃短血管时易造成出血和脾脏损伤,尤其在一些脾脏上极脾胃韧带较短的肥胖患者。笔者团队前期采用胃后间隙预先拓展的手术方法,很好地解决了这一问题。本研究通过比较腹腔镜下预先拓展胃后间隙的近端胃癌根治术和常规的近端胃癌根治术的临床效果,探讨预先拓展胃后间隙的手术方法在腹腔镜近端胃癌根治术中的应用价值。方法:回顾性分析蚌埠医学院第一附属医院肿瘤外科2019年1月—2021年12月间196例接受腹腔镜近端胃癌根治术患者的临床资料,其中99例采用腹腔镜下预先拓展胃后间隙的近端胃癌根治术(研究组),97例行常规的近端胃癌根治术(对照组),比较两组患者的临床指标。结果:两组患者在年龄、性别、BMI、肿瘤位置、肿瘤分期、手术方式、食管空肠吻合方式等一般资料方面差异均无统计学意义(均P>0.05)。两组所有患者均顺利完成腹腔镜手术,淋巴结清扫范围相同,无中转开腹。与对照组比较,研究组手术平均时间明显缩短[(100.3±25.8)min vs.(130.7±43.2)min,P=0.000]、平均出血量明显减少[(35.0±5.7)mL vs.(44.9±4.7)mL,P=0.000]。对照组术中发生脾脏上极损伤5例(5.2%),研究组无术中脾损伤发生,但差异无统计学意义(P>0.05)。两组在淋巴结清扫数目、术后引流量、引流时间、术后住院时间、住院费用和手术并发症发生率方面差异均无统计学意义(均P>0.05)。两组患者均无严重术后并发症发生。结论:预先拓展胃后间隙的手术方法在腹腔镜近端胃癌根治术中具有术中出血少,手术时间短,降低医源性脾损伤的优点,因此,推荐临床使用。Background and Aims:In radical gastrectomy for proximal gastric cancer,bleeding and spleen damage are likely to occur when dealing with short gastric vessels,especially in some obese patients with short spleen-gastric ligaments at the upper pole of the spleen.The author's team has previously used a surgical method of pre-expanding the posterior gastric space,which effectively solves this problem.This study was performed to compare the clinical efficacy of laparoscopic proximal gastrectomy with pre-expansion of the retrogastric space versus conventional laparoscopic proximal gastrectomy,and explore the value of the pre-expansion method in laparoscopic proximal gastrectomy for gastric cancer.Methods:The clinical data of 196 patients who underwent laparoscopic proximal radical gastrectomy in the Department of Oncology of the First Affiliated Hospital of Bengbu Medical College from January 2019 to December 2021 were retrospectively analyzed.Of the patients,99 cases underwent radical proximal gastrectomy with pre-expansion of the retrogastric space(study group),97 cases received conventional proximal gastrectomy(control group).The clinical variables were compared between the two groups of patients.Results:There were no significant differences in general information such as age,sex,BMI,tumor location,tumor stage,surgical method,and esophagojejunostomy method between the two groups(all P>0.05).All patients in both groups completed the laparoscopic surgery uneventfully,with the same range of lymph node dissection and without conversion to open surgery.Compared with the control group,the study group had a significantly shorter average operative time[(100.3±25.8)min vs.(130.7±43.2)min,P=0.000]and significantly less average intraoperative blood loss[(35.0±5.7)mL vs.(44.9±4.7)mL,P=0.000].Splenic injury occurred in 5 cases(5.2%)in the control group during the surgery,while no intraoperative spleen injury occurred in the study group,but the difference was not statistically significant(P>0.05).There were no statistically si

关 键 词：胃肿瘤 胃切除术 腹腔镜 淋巴结切除术 胃背系膜 

分 类 号：R735.2[医药卫生—肿瘤]