腹腔镜远端胃切除术与保留幽门胃切除术治疗早期胃癌的疗效对比研究  

Comparative effectiveness research of laparoscopic distal gastrectomy and pylorus preserving gastrectomy in the treatment of early gastric cancer

作　　者：张前进[1] 赵军抗 ZHANG Qianjin;ZHAO Junkang(Department of General Surgery,Xuzhou Central Hospital,Xuzhou 221009,China)

机构地区：[1]徐州市中心医院普通外科,江苏徐州221009

出　　处：《腹腔镜外科杂志》2024年第8期588-593,共6页Journal of Laparoscopic Surgery

摘　　要：目的:对比腹腔镜远端胃切除术(LDG)与保留幽门胃切除术(LPPG)治疗早期胃癌的有效性与安全性。方法:选取2018年3月至2022年3月收治的108例早期胃癌患者,根据手术方式分为两组,68例行LDG(LDG组),40例行LPPG(LPPG组),对比分析两组手术情况、术后恢复情况、术后并发症发生率、住院费用等。结果:两组手术时间、术中出血量、淋巴结清扫数量、术后恢复相关指标(首次排气、排便、进食、引流管拔除、胃管拔除、住院时间)差异无统计学意义(P>0.05)。与LDG组相比,LPPG组肿瘤远切缘短,住院总费用低,胃排空延迟发生率高(30.00%vs.7.35%),反酸发生率低(0 vs. 20.59%),差异有统计学意义(P<0.05)。LDG组与LPPG组术后并发症总发生率差异无统计学意义(32.35%vs. 35.00%,P>0.05)。术后1年,LPPG组继发性胆汁反流性胃炎的发生率低于LDG组,Ⅱ~Ⅲ度胆汁反流性胃炎发生率亦低于LDG组(P<0.05)。LDG组与LPPG组3年生存率差异无统计学意义(80.88%vs. 80.00%,P>0.05)。结论:LPPG与LDG治疗早期胃癌均具有较好效果,LPPG更有助于减少术后反酸及继发性胆汁反流性胃炎的发生,治疗费用更低。Objective:To compare the effectiveness and safety of laparoscopic distal gastrectomy(LDG)and laparoscopic pylorus preserving gastrectomy(LPPG)in the treatment of early gastric cancer.Methods:From Mar.2018 to Mar.2022,108 patients with early gastric cancer were selected and divided into two groups based on different surgical treatments:68 patients underwent LDG(LDG group)and 40 patients underwent LPPG(LPPG group).The surgical outcomes,postoperative recovery,postoperative complications i ncidence and hospitalization expenses were compared between two groups.Results:There were no significant differences in surgical time,intraoperative blood loss,number of lymph node dissected,postoperative recovery time(first exhaust,first defecation,first diet,drainage tube removal,gastric tube removal,hospital stay)between the two groups(P>0.05).The distance to distant incision margin of the tumor in LPPG group was significantly shorter than that in LDG group(P<0.05).The total hospitalization expenses of LPPG group were lower than those of LDG group(P<0.05).The incidence of delayed gastric emptying in LDG group was lower than that in LPPG group(7.35%vs.30.00%,P<0.05),and the incidence of acid reflux was higher than that in LPPG group(20.59%vs.0,P<0.05).The postoperative complications total incidence of LDG group and LPPG group was similar(32.35%vs.35.00%,P>0.05).Compared with LDG group,the incidence of secondary bile reflux gastritis in LPPG group was lower in 1 year after surgery,and the incidence of gradeⅡtoⅢbile reflux gastritis was also lower(P<0.05).The 3-year survival rate between the LDG group and LPPG group was not significantly different(80.88%vs.80.00%,P>0.05).Conclusions:In the clinical treatment of early gastric cancer,both L PPG and LDG have good effects,but the former is more helpful in reducing postoperative acid reflux and secondary bile reflux gastritis,with lower treatment costs.

关 键 词：胃肿瘤 远端胃切除术 保留幽门胃切除术 腹腔镜检查 疗效比较研究 

分 类 号：R735.2[医药卫生—肿瘤]