腹腔镜胃癌根治术联合托出式脾门入路淋巴结清扫治疗胃癌的效果观察  

Effect of laparoscopic radical gastrectomy combined with pull-out splenic hilum approach lymph node dissection in the treatment of gastric cancer

作　　者：朱中秀 吉蓓蓓 王术 ZHU Zhong-xiu;JI Bei-bei;WANG Shu(Department of Gastrosurgery,Jiangsu Cancer Hospital,Jiangsu Institute of Cancer Hospital,The Affiliated Cancer Hospital of Nanjing Medical University,Nanjing Jiangsu 210000,China)

机构地区：[1]江苏省肿瘤医院(江苏省肿瘤防治研究所南京医科大学附属肿瘤医院)胃外科,江苏南京210000

出　　处：《临床和实验医学杂志》2024年第1期57-60,共4页Journal of Clinical and Experimental Medicine

基　　金：国家自然科学基金青年基金项目(编号:82203226)。

摘　　要：目的研究腹腔镜胃癌根治术(LTG)与托出式脾门入路淋巴结清扫(TLND)联合治疗胃癌的效果。方法以前瞻性分析为法,选取2019年1至12月江苏省肿瘤医院收治入院的80例胃癌患者为研究对象,按照随机数字表法将其分为两组:观察组(n=43)与对照组(n=37)。对照组实施开腹手术联合托出式脾门TLND,观察组实施LTG与托出式脾门TLND。比较两组手术近期疗效(手术时间、术中出血量、总淋巴结清扫数量、脾门淋巴结检出数量、腹部切口长度、首次流质食物摄入时间以及术后住院时间)、生活质量、肿瘤学指标[癌胚抗原、甲胎蛋白、糖类抗原(CA)199、CA724]、术后并发症、远期疗效。结果观察组的手术时间为(243.16±47.51)min,长于对照组[(193.42±39.85)min],术中出血量为(114.78±60.84)mL,少于对照组[(201.46±70.49)mL],腹部切口长度、首次流质食物摄入时间以及术后住院时间分别为(6.33±1.15)cm、(5.19±2.31)d、(11.92±2.15)d,均短于对照组[(17.52±4.85)cm、(7.45±2.62)d、(14.99±3.49)d],总淋巴结清扫数量、脾门淋巴结检出数量分别为(25.75±4.31)、(5.23±1.43)枚,均高于对照组[(22.23±3.44)、(3.41±1.62)枚],差异均有统计学意义(P<0.05)。手术后1个月,两组患者生活质量评分中主观症状、社会活动功能、生理功能、心理情绪以及生存质量指数(GLQI)总分均下降,且观察组分别为(60.41±4.75)、(10.65±1.64)、(17.51±3.21)、(12.31±1.02)、(103.39±4.19)分,均明显低于对照组[(66.98±5.13)、(12.28±1.56)、(19.19±3.35)、(13.88±1.34)、(113.27±4.98)分],差异均有统计学意义(P<0.05)。手术后1个月,两组患者血清癌胚抗原、甲胎蛋白、CA199、CA724水平均较手术前降低,且观察组血清癌胚抗原、甲胎蛋白、CA199、CA724水平分别为(10.87±2.33)μg/L、(10.42±5.41)ng/mL、(40.16±7.42)U/L、(6.31±1.03)U/mL,均明显低于对照组[(15.78±2.84)μg/L、(16.49±4.87)ng/mL、(60.46±10.48)U/L、(8.42±1.0Objective To investigate the efficacy of laparoscopic radical gastrectomy(LTG)and propulsive hilar splenic approach therapeutic lymph node dissection(TLND)in the treatment of gastric cancer.Methods In a prospective analysis,80 gastric cancer patients admitted to Jiangsu Cancer Hospital from January to December 2019 were selected as the study subjects.They were randomly divided into two groups according to the random number table method:the observation group(n=43)and the control group(n=37).The control group received laparotomy combined with propulsive hilus TLND,and the observation group received LTG and propulsive hilus TLND.The short-term efficacy(operation time,intraoperative blood loss,total number of lymph node dissection,number of splenic lymph node detections,length of the abdominal incision,time of first fluid food intake,and postoperative hospitalization time),quality of life,oncological indicators[carcinoembryonic antigen,alpha fetoprotein,carbohydrate antigen(CA)199,CA724],postoperative complications,and long-term efficacy of the two groups were compared.Results The operation time of the observation group was(243.16±47.51)min,which was longer than that of the control group[(193.42±39.85)min],and the intraoperative blood loss was(114.78±60.84)mL,which was less than that of the control group[(201.46±70.49)mL],the length of the abdominal incision,the time of first liquid food intake,and the postoperative hospitalization time were(6.33±1.15)cm,(5.19±2.31)d,and(11.92±2.15)d,which were shorter than those in the control group[(17.52±4.85)cm,(7.45±2.62)d,(14.99±3.49)d],the total number of lymph node dissection,number of splenic lymph node detections in the splenic hilar were(25.75±4.31)and(5.23±1.43),respectively,which were higher than in the control group[(22.23±3.44)and(3.41±1.62)],and the differences were statistically significant(P<0.05).One month after surgery,the subjective symptoms,social activity function,physiological function,psychological emotion,and total score of Gastrointestinal Lif

关 键 词：胃肿瘤 胃癌根治术 腹腔镜 托出式脾门入路淋巴结清扫 淋巴结 疗效 远期预后 

分 类 号：R735.2[医药卫生—肿瘤]