腹腔镜下D2根治术联合CME对局部进展期胃癌术后腹腔游离癌细胞检出率及预后的影响  

Effect of laparoscopic D2 radical resection combined with CME on the detection rate of free cancer cells in abdominal cavity and prognosis of locally advanced gastric cancer

作　　者：李永坤[1] 彭朝阳[1] 贾亚鹏 王虔 刘耿[1] LI Yongkun;PENG Chaoyang;JIA Yapeng;WANG Qian;LIU Geng(General Surgery Department,the First Affiliated Hospital of Nanyang Medical College,Henan Nanyang 473000,China)

机构地区：[1]南阳医学高等专科学校第一附属医院普通外科,河南南阳473000

出　　处：《现代肿瘤医学》2024年第12期2224-2229,共6页Journal of Modern Oncology

基　　金：河南省医学科技攻关计划(编号:LHGJ20220807)。

摘　　要：目的:探讨腹腔镜下D2根治术联合完整系膜切除术(complete mesocolic excision,CME)对局部进展期胃癌腹腔游离癌细胞及预后的影响。方法:回顾性分析2021年06月至2022年06月于医院住院治疗的128例局部进展期胃癌患者临床资料,将64例实施腹腔镜下D2根治术的患者纳入对照组,64例实施腹腔镜下D2根治术联合CME的患者纳入研究组。记录两组手术、住院及并发症情况,采用生活质量综合评定问卷-74(GQOLI-74)评定生活质量。分别于腹腔镜探查后和肿瘤切除后收集腹腔冲洗液,应用细胞学检查检测腹腔游离癌细胞。术后随访1年,记录总生存期(OS)及无进展生存期(PFS)情况。结果:研究组淋巴结清扫总数及阳性淋巴结数量显著大于对照组(P<0.05)。与术前比较,研究组术后腹腔游离癌细胞阳性率显著降低(P<0.05)。与术前比较,两组术后GQOLI-74评分均显著增加,且研究组高于对照组(P<0.05)。两组腹腔感染/积液、胃排空障碍、肠梗阻、吻合口瘘、胰瘘、淋巴漏发生率及不良反应总发生率比较,差异均无统计学意义(P>0.05)。研究组术后1年PFS率和OS率均显著高于对照组(P<0.05)。结论:腹腔镜下D2根治术联合CME有利于彻底清除局部进展期胃癌淋巴结,减少术后复发,促进术后康复,且不增加腹腔游离癌细胞脱落和手术并发症风险,具有临床推广价值。Objective:To investigate the effect of laparoscopic D2 radical resection combined with complete mesocolic excision(CME)on free cancer cells in abdominal cavity and prognosis of locally advanced gastric cancer.Methods:The clinical data of 128 patients with locally advanced gastric cancer hospitalized from June 2021 to June 2022 were retrospectively analyzed.Sixty-four patients who underwent laparoscopic D2 radical resection were included in the control group,and 64 patients who underwent laparoscopic D2 radical resection combined with CME were included in the study group.The operation,hospitalization and complications of the two groups were recorded,and the quality of life was assessed by the generic quality of life inventory(GQOLI-74).Peritoneal lavage fluid was collected after laparoscopic exploration and tumor resection respectively,and peritoneal free cancer cells were detected by cytology.The patients were followed up for one year,and the overall survival(OS)and progression-free survival(PFS)were recorded.Results:The total number of lymph node dissection and positive lymph nodes in the study group were significantly greater than those in the control group(P<0.05).Compared with before operation,the positive rate of free cancer cells in abdominal cavity in the study group decreased significantly after operation(P<0.05).Compared with pre-operation,the scores of GQOLI-74 in both groups increased significantly after operation,and the scores in the study group were higher than those in the control group(P<0.05).There was no significant difference in the incidence of abdominal infection/effusion,gastric emptying disorder,intestinal obstruction,anastomotic leakage,pancreatic leakage,lymphatic leakage and the total incidence of adverse reactions between the two groups(P>0.05).The PFS rate and OS rate in the study group were significantly higher than those in the control group one year after operation(P<0.05).Conclusion:Laparoscopic D2 radical resection combined with CME is beneficial to completely remove lymph nodes o

关 键 词：局部进展期胃癌 腹腔镜下D2根治术 完整系膜切除术 腹腔游离癌细胞 预后 

分 类 号：R735.2[医药卫生—肿瘤]