远端胃癌患者行微创手术结合三角吻合的长期预后研究*

Long-term prognosis of patients with distal gastric cancer underwent minimally invasive surgery combined with delta-shaped anastomosis*

摘要:

目的 探讨全腹腔镜下远端胃癌根治术（TLDG）加三角吻合（DA）治疗远端胃癌的长期疗效。 方法 回顾性收集2014 年1 月－ 2016 年4 月于浙江衢化医院行腹腔镜远端胃癌根治术治疗的128 例远端胃 癌患者的临床资料。根据手术方式的不同，分为TLDG 加DA 治疗组（DA 组，72 例）和腹腔镜辅助下远端 胃癌根治术（LADG）加管状吻合（TA）治疗组（TA 组56 例）。记录两组手术时间、术中出血量、拆线时 间、术后排气时间、淋巴结清扫数目、住院时间和术后并发症情况。采用电话随访的形式每个月定期随访， 随访截至2017 年4 月。结果 DA 组术中出血量（55.6±12.5）ml 和术后排气时间（2.5±1.0）d 均明显低于 TA 组的（85.6±15.8）ml 和（4.5±1.5）d，差异有统计学意义（P <0.05），两组手术时间、拆线时间、淋巴 结清扫数目和住院时间比较差异均无统计学意义（P >0.05）。DA 组吻合口狭窄（0.00%）、吻合口瘘（0.00%） 和吻合口出血（0.00%）发生率明显低于TA 组的7.14%、8.93% 和7.14%，差异有统计学意义（P <0.05）。DA 组全部获得有效随访，随访时间16 ～ 62 个月，16 例患者死于肿瘤复发或转移，累积生存率77.78%。TA 组全 部获得有效随访，随访时间15 ～ 61 个月，14 例患者死于肿瘤复发或转移，累积生存率75.00%。DA 组和TA 组累积生存率比较差异无统计学意义（P >0.05）。结论 在远端胃癌的治疗中，与LADG 加TA 相比，采用 TLDG 加DA 近期疗效存在一定的优势，但两者远期疗效相当。

Abstract:

Objective To evaluate the long-term efficacy of total laparoscopic radical gastrectomy combined with delta-shaped anastomosis in treatment of distal gastric cancer. Methods The clinical data of 128 patients with distal gastric cancer who underwent laparoscopic radical gastrectomy from January 2014 to April 2016 were retrospectively reviewed. According to the different surgical methods, patients were divided into TLDG plus DA treatment group (DA group, 72 cases) and LADG plus TA treatment group (TA group, 56 cases). The operation time, intraoperative blood loss, disconnection time, postoperative exhaust time, lymph node dissection, hospitalization time and postoperative complications were recorded. Patients were followed up monthly by call, toApril 2017. Results The blood loss [(55.6 ± 12.5) vs (85.6 ± 15.8) ml] and postoperative exhaust time [(2.5 ± 1.0) vs (4.5 ± 1.5) d] were significantly lower in the DA group than that in TA group (P < 0.05). There was no significant difference between the two groups in the operation time, the removal time, the number of lymph node dissection and the hospitalization time (P > 0.05). The incidence of anastomotic stenosis (0.00% vs 7.14%), anastomotic fistula (0.00% vs 8.93%) and anastomotic bleeding (0.00% vs 7.14%) in DA group was significantly lower than that in TA group (P < 0.05). All the patients were followed up for 16 to 62 months in DA group. 16 patients died of tumor recurrence or metastasis, and the cumulative survival rate was 77.78%. TA group were all effective followup, the follow-up time of 15 to 61 months, 14 patients died of tumor recurrence or metastasis, the cumulative survival rate of 75.00%. There was no significant difference in cumulative survival rate between DA group and TA group (P > 0.05). Conclusion In the treatment of distal gastric cancer, there is a certain advantage in the effect of laparoscopic radical gastrectomy plus delta-shaped anastomosis in the treatment of distal gastric cancer over tubular anastomosis.