规范化淋巴结分拣对胃食管结合部恶性肿瘤手术治疗的效果  

Effect of standardized lymph node sorting on surgical treatment of gastroesophageal junction malignant tumors

作　　者：何辉虎 高凯绩 孙家和 姚启杨 张士杰 耿灵钧 He Huihu;Gao Kaiji;Sun Jiahe;Yao Qiyang;Zhang Shijie;Geng Lingjun(Dept of General Surgery,Fuyang Hospital of Anhui Medical University,Fuyang 236000;Dept of Oncology,The First Affiliated Hospital of Bengbu Medical University,Bengbu 233004)

机构地区：[1]安徽医科大学附属阜阳医院普外科,阜阳236000 [2]蚌埠医科大学第一附属医院肿瘤外科,蚌埠233004

出　　处：《安徽医科大学学报》2024年第8期1465-1470,共6页Acta Universitatis Medicinalis Anhui

基　　金：安徽省高校自然科学研究项目(编号:2023AH050598)。

摘　　要：目的 探讨手术后规范淋巴结分拣对胃食管结合部恶性肿瘤手术疗效的影响。方法 回顾性分析医院外科胃癌数据库中所有胃食管结合部恶性患者资料,根据手术后是否有外科医生立即进行淋巴结分拣,将患者分为淋巴结分拣组(分拣组)和淋巴结未分拣组(未分拣组);一般资料包括性别、年龄、体质量指数(BMI)、癌胚抗原(CEA)、术前白蛋白水平、术前血红蛋白等,围术期及病理资料包括手术时间、术中出血量、术后住院时间、肿瘤分化程度、肿瘤距上切缘距离、淋巴结总数、阳性淋巴结数等;使用Kaplan-Meier曲线和Log-rank检验进行生存分析,倾向性评分匹配分析调整组间混杂因素。结果 共纳入患者386例,淋巴结分拣组、未分拣组分别为133、253例,中位随访时间40.18月;分拣组淋巴结总数、阳性淋巴结数分别为(26.38±12.18)、(6.63±10.14)枚,未分拣组淋巴结总数、阳性淋巴结数分别为(12.25±7.06)、(3.07±3.77)枚,淋巴结分拣组与未分拣组在淋巴结总数、阳性淋巴结数差异均有统计学意义(P<0.05),未匹配前分拣组和未分拣组生存差异无统计学意义;两组进展期胃癌患者分别为112、203例,分拣组患者总体生存曲线优于未分拣组,中位生存时间差异有统计学意义(P<0.05);将卡钳值设置为0.02,倾向性匹配94对患者,匹配后分拣组淋巴结总数、阳性淋巴结数分别为(24.71±12.03)、(5.70±9.95)枚,未分拣组淋巴结总数、阳性淋巴结数分别为(13.05±7.63)、(3.37±4.32)枚,两组差异有统计学意义(P<0.05),分拣组患者总体生存曲线优于未分拣组,中位生存时间差异有统计学意义(P<0.05)。结论 胃癌术后淋巴结分拣可显著提高总淋巴结、阳性淋巴结送检数目,降低淋巴结迁移,改善术后生存时间。Objective To investigate the effect of standardized lymph node sorting on postoperative results of gastroesophageal junction malignant tumors.Methods The data of all patients with malignant gastroesophageal junction in gastric cancer database were analyzed retrospectively.Lymph nodes were sorted according to whether surgeons were present immediately after surgery.Patients were divided into lymph node sorting group(sorting group)and lymph node unsorting group(unsorting group).General data included gender,age,body mass index(BMI),carcinogenic antigen(CEA),postoperative albumin level,preoperative hemoglobin,etc.Perioperative and pathological data included operation time,intraoperative blood loss,postoperative hospital stay,tumor differentiation,distance from superior incisal margin,total number of lymph nodes,number of positive lymph nodes,etc.Kaplan-Meier curve and Log-rank test were used for survival analysis,and propensity score matching analysis adjusted for confounding factors between groups.Results A total of 386 patients were included,including 133 in lymph node sorting group and 253 in non-sorting group.The median follow-up time was 40.18 months.The total number of lymph nodes and the number of positive lymph nodes in the sorting group were(26.38±12.18)and(6.63±10.14),respectively,while the total number and the number of positive lymph nodes in the non-sorting group were(12.25±7.06)and(3.07±3.77),respectively.There were statistically significant differences in the total number of lymph nodes and the number of positive lymph nodes between the sorting group and the non-sorting group(P<0.05).There was no statistically significant difference in survival between the sorting group and the non-sorting group before matching.There were 112 and 203 patients with advanced gastric cancer in the two groups,respectively.The overall survival curve of patients in the sorting group was better than that in the non-sorting group,and the difference in median survival time was statistically significant(P<0.05).The caliper va

关 键 词：食管胃结合部恶性肿瘤 淋巴结分拣 生存期 倾向性匹配 

分 类 号：R61[医药卫生—外科学]