摘要
目的:探讨保留胃网膜右静脉第一分支完全腹腔镜保留幽门胃切除术(TLPPG)治疗早期胃癌的临床疗效。方法:采用回顾性描述性研究方法。收集2018年7月至2021年5月扬州大学附属苏北人民医院收治的38例早期胃癌患者的临床病理资料;男18例,女20例;年龄为60(39~73)岁。患者均行保留胃网膜右静脉第一分支TLPPG。观察指标:(1)手术及术后情况。(2)术后组织病理学检查情况。(3)随访情况。采用门诊、微信、病案复查等方式进行随访,了解患者营养状况、残胃功能、胆囊结石情况及患者复发、转移和死亡情况。随访时间截至2022年7月。正态分布的计量资料以x±s表示,偏态分布的计量资料以M(范围)表示。计数资料以绝对数表示。结果:(1)手术及术后情况。38例患者均行保留胃网膜右静脉第一分支TLPPG,无中转开腹手术;手术时间为(180±28)min,术中出血量为(58±38)mL,术后首次肛门排气时间为(2.7±0.6)d,术后首次进食流质食物时间为(3.4±0.7)d,术后住院时间为(10.3±2.8)d。38例患者中,6例术后发生Clavien-Dindo分级≥Ⅱ级并发症。(2)术后组织病理学检查情况。38例患者肿瘤长径为(1.8±0.5)cm,近端切缘距离肿瘤(3.4±0.2)cm,远端切缘距离肿瘤(4.3±0.4)cm,近、远端切缘均为阴性;淋巴结检查数目为(23.3±3.9)枚/例,第6组淋巴结检查数目为(3.4±1.1)枚/例;病理学T1期38例(病理学T1a期23例、病理学T1b期15例);病理学N0期36例,病理学N1期2例;病理学TNM分期ⅠA期36例,ⅠB期2例。(3)随访情况。38例患者均获得随访,随访时间为18(12~48)个月。38例患者术后6个月血红蛋白、血清白蛋白、血清总蛋白分别为(125.4±5.8)g/L、(42.4±2.3)g/L、(71.6±2.1)g/L;术后12个月内镜检查评估患者残胃功能,4例残胃中等量食物残留,无患者发生反流性食管炎、反流性胃炎及胆汁反流。38例患者术后均未行化疗,无复发、转移和死亡。结论:保留胃�
Objective To investigate the clinical efficacy of totally laparoscopic pylorus-preserving gastrectomy(TLPPG)with preservation of the first branch of the right gastroepiploic vein in early gastric cancer(EGC).Methods The retrospective and descriptive study was conducted.The clinicopathological data of 38 EGC patients who were admitted to the Subei Hospital Affiliated to Yangzhou University from July 2018 to May 2021 were collected.There were 18 males and 20 females,aged 60(range,39‒73)years.All patients underwent TLPPG with preservation of the first branch of the right gastroepiploic vein.Observation indicators:(1)surgical and postoperative condi-tions;(2)postoperative histopathological examination.(3)follow-up.Follow-up was conducted using outpatient examination,WeChat interview and medical record review to detect the nutritional status,residual stomach function,cholecystolithiasis,tumor recurrence and metastasis and death of patients.Follow-up was up to July 2022.Measurement data with normal distribution were represented as Mean±SD,and measurement data with skewed distribution were represented as M(range).Count data were described as absolute numbers.Results(1)Surgical and postoperative conditions.All 38 patients underwent TLPPG with preservation of the first branch of the right gastroepiploic vein successfully,without laparotomy conversion.The operation time,volume of intraoperative blood loss,time to postoperative first flatus,time to postoperative first liquid food intake and duration of postoperative hospital stay of the 38 patients were(180±28)minutes,(58±38)mL,(2.7±0.6)days,(3.4±0.7)days and(10.3±2.8)days,respectively.Of the 38 patients,there were 6 cases with postoperative complications≥gradeⅡof Clavien-Dindo classification.(2)Postoperative histopatho-logical examination.The tumor diameter,distance from proximal resection margin to tumor and distance from distal resection margin to tumor of the 38 patients were(1.8±0.5)cm,(3.4±0.2)cm and(4.3±0.4)cm,respectively.Both of proximal and distal r
作者
张琪
周家杰
汤东
王伟
任俊
孙倩男
王勇
嵇晋
赵凡宇
王道荣
Zhang Qi;Zhou Jiajie;Tang Dong;Wang Wei;Ren Jun;Sun Qiannan;Wang Yong;Ji Jin;Zhao Fanyu;Wang Daorong(Subei Hospital Affiliated to Yangzhou University,Yangzhou 225001,Jiangshu Province,China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2023年第1期144-149,共6页
Chinese Journal of Digestive Surgery
基金
国家自然科学基金资助项目(81972269)
消化病/代谢病基础与临床转化重点实验室项目(YZ2020159)。
关键词
胃肿瘤
早期
保留幽门胃切除术
三角吻合
腹腔镜检查
Stomach neoplasms
Early stage
Pylorus-preserving gastrectomy
Trian-gular anastomosis
Laparoscopy
