摘要
目的研究基于膜解剖理论的腹腔镜D_(2)根治术+完整系膜切除术(CME)在进展期胃癌中的应用效果及其安全性。方法前瞻性选取2019年3月至2021年5月于琼海市中医院就诊的进展期胃癌患者92例,采用随机数字表法分为研究组和对照组,每组46例。研究组行膜解剖理论指导下腹腔镜辅助D_(2)根治术+CME治疗,对照组行标准腹腔镜辅助D_(2)根治术治疗。观察两组围手术期相关指标及术后并发症发生情况,Kaplan-Meier曲线分析预后生存情况。结果两组均顺利完成手术,术中无中转开腹发生。研究组手术时间、术中出血量、术后首次排气排便时间及住院时间低于对照组,淋巴结清扫数及阳性淋巴结检出数多于对照组(均P<0.05)。两组总并发症发生率差异无统计学意义(χ2=3.023,P=0.082)。研究组术后复发率及3年累积总生存率优于对照组(χ2=4.564、3.861,P=0.033、0.046)。结论基于膜解剖理论的腹腔镜辅助D_(2)根治术联合CME治疗进展期胃癌安全可行,术时短、出血少且淋巴结清扫更彻底,能有效促进术后恢复,降低肿瘤复发,提高患者生存率。
Objective To investigate the efficacy and safety of laparoscopic D2 radical gastrectomy with complete mesorectal excision(CME)under the guidance of mesenteric anatomy theory in advanced gastric cancer.Methods A total of 92 patients with advanced gastric cancer treated in Qionghai Traditional Chinese Medicine Hospital from March 2019 to May 2021 were prospectively selected and divided into study group and control group by numerical random method,with 46 cases in each group.The study group was treated with laparoscopic D2 radical resection plus CME based on the theory of mesenteric anatomy,while the control group was treated with standard laparoscopic D2 radical gastrectomy.The perioperative indicators and postoperative complications of the two groups were observed.Kaplan-Meier curve was used to analyze the prognosis and survival.Results Both groups successfully completed the operation without conversion to laparotomy.The operation time,intraoperative blood loss,time of fi rst exhaust/defecation and hospitalization in the study group were shorter than those in the control group,and the number of cleared lymph nodes and detected positive lymph nodes in the study group were more than those in the control group(all P<0.05).There was no signifi cant difference in the total incidence of complications between the two groups(χ2=3.023,P=0.082).The recurrence rate and 3-year cumulative total survival rate in the study group were better than those in the control group(χ2=4.564、3.861;P=0.033,0.046).Conclusion Laparoscopic D2 radical gastrectomy plus CME for advanced gastric cancer based on the theory of mesenteric anatomy is safe and feasible,with shorter operation time,less blood loss and more thorough lymph node dissection,which can effectively promote postoperative recovery,reduce tumor recurrence and improve the survival rate.
作者
王纯恩
吴惠慈
王德奋
林中满
Wang Chun’en;Wu Huici;Wang Defen;Lin Zhongman(The First Department of General Surgery,Qionghai Traditional Chinese Medicine Hospital,Qionghai 571400,China)
出处
《中华普通外科学文献（电子版）》
CAS
2023年第2期124-128,共5页
Chinese Archives of General Surgery(Electronic Edition)
关键词
胃肿瘤
系膜解剖理论
胃切除术
完整系膜切除
Stomach neoplasms
Mesenteric anatomy theory
Gastrectomy
Complete mesorectal excision
