摘要
目的探讨腹腔镜手术治疗浆膜受侵进展期胃癌的疗效及生存情况。方法回顾性分析208例浆膜受侵进展期胃癌患者的病历资料,按照手术方法分为观察组108例(腹腔镜下胃癌根治术)及对照组100例(常规开腹胃癌根治术),并根据浆膜受侵面积将观察组分为A组24例(≤1 cm^2),B组30例(﹥1 cm^2且≤5 cm^2),C组28例(﹥5 cm^2且≤10 cm^2),D组26例(﹥10 cm^2)。观察两组治疗效果,比较两组手术开始及手术结束时腹腔冲洗液中癌胚抗原(CEA)及多巴脱羧酶(DDC)水平,计算和分析患者术后1年、3年无瘤生存率及总生存率,观察不同浆膜受侵面积患者的生存率。结果观察组患者手术切口长度明显短于对照组,术中出血量明显少于对照组,排气时间及住院时间均明显短于对照组,差异均有统计学意义(P﹤0.01);观察组患者术后并发症发生率为6.5%(7/108),低于对照组的15.0%(15/100),差异有统计学意义(P﹤0.05)。手术开始时,两组患者腹腔冲洗液中CEA及DDC水平比较,差异均无统计学意义(P﹥0.05);手术结束时,两组患者CEA及DDC水平均升高,且观察组CEA及DDC水平均低于对照组,差异均有统计学意义(P﹤0.05)。两组患者1年、3年无瘤生存率及总生存率比较,差异均无统计学意义(P﹥0.05)。随访3年,108例行腹腔镜下胃癌根治术患者的总生存率为76.9%;A～D组患者3年生存率分别为91.7%、83.3%、71.4%和61.5%,4组比较,差异有统计学意义(P﹤0.05)。结论浆膜受侵进展期胃癌患者预后与浆膜受侵面积有关,行腹腔镜下胃癌根治术疗效满意,组织创伤小,能够降低微转移指标水平。
Objective To investigate the efficacy of laparoscopy in the treatment of advanced gastric cancer with serosal invasion.Method208patients with advanced gastric cancer with serosal invasion were included,with108cases in observation group(laparoscopic radical gastrectomy),and100cases in control group(routine open radical gastrectomy),furthermore,patients in observation group were subdivided by the area of serosal invasion as group A with24cases(≤1cm^2),group B with30cases(>1cm^2and≤5cm^2),group C with28cases(>5cm2and≤10cm^2),and group D with26cases(>10cm^2).The efficacy in the two groups were observed,meanwhile,the level of carcinoembryonic antigen(CEA)and dopa decarboxylase(DDC)at the beginning and end of operation in the two groups were compared,besides,the tumor-free survival rate and overall survival rate in1and3years after operation were calculated,and the survival rate of patients with different area of serosal invasion was observed.Result The length of incision in observation group was significantly shorter than that in control group,and same results were noted for the intraoperative blood loss and time to anal exhaust as well as hospital stay,the differences were statistically significant(P<0.01);the incidence rate of postoperative complications in observation group was6.5%(7/108),which was lower than the15.0%(15/100)in control group(P<0.05).At the end of operation,the levels of CEA and DDC increased in both groups,while were lower in observation group compared with control group,showing statistically significant difference(P<0.05).There was no significant difference in1-and3-year tumor-free survival rate and overall survival rate between the two groups(P>0.05).After3years of follow up,the overall survival rate of108patients undergoing laparoscopic radical gastrectomy was76.9%,and the3-year survival rates in group A-D were91.7%,83.3%,71.4%and61.5%,respectively,indicating significant difference(P<0.05).Conclusion The prognosis of patients with advanced gastric cancer with serosal invasion is related to
作者
李天雄
尹刚
孙志鹏
杜德晓
廉东波
闫巍
樊庆
阿民布和
张能维
LI Tianxiong;YIN Gang;SUN Zhipeng;DU Dexiao;LIAN Dongbo;YAN Wei;FAN Qing;AMIN Buhe;ZHANG Nengwei(Department of Gastrointestinal and Hepatobiliary Tumor Surgery, Beijing Shijitan Hospital Affiliated to Capital Medical University,Beijing 100038, China)
出处
《癌症进展》
2018年第14期1765-1767,1789,共4页
Oncology Progress
关键词
腹腔镜
胃癌根治术
胃肿瘤
浆膜
转移
laparoscopy
radical gastrectomy
gastric cancer
serosa
metastasis
