腹腔镜辅助下远端胃癌根治术在进展期胃癌中的应用

Application of laparoscopy-assisted radical gastrectomy for distal gastric cancer in advanced gastric cancer

摘要:

目的 探讨腹腔镜辅助下远端胃癌根治术在进展期胃癌中的疗效与安全性。方法 选取2017年6月－2019年6月该院收治的70例进展期胃癌患者为研究对象，随机分为对照组（n = 35）和观察组（n = 35）。对照组患者行开腹远端胃癌根治术，观察组患者行腹腔镜辅助下远端胃癌根治术；比较两组患者手术指标、术后恢复情况、血清炎症因子水平、术后并发症和生存率。结果 观察组切口长度为（5.7±0.8）cm，明显较对照组的（20.6±1.9）cm短（P < 0.05）；术中出血量为（185.2±68.6）mL，明显较对照组的（387.4±120.5）mL少（P < 0.05）。观察组手术时间为（275.3±42.6）min，明显较对照组的（201.5±29.8）min长（P < 0.05）。观察组淋巴结清扫数目为（23.6±5.8）个，与对照组的（24.2±6.1）个比较，差异无统计学意义（P > 0.05）。观察组下床时间（2.9±0.9）d、术后排气时间（4.1±0.7）d和住院时间（13.1±2.8）d，明显较对照组的（4.8±1.2）、（5.2±1.1）和（20.2±4.3）d短（P < 0.05）。术后3 d，观察组C反应蛋白（CPR）（18.3±1.4）mg/L、白细胞介素-6（IL-6）（92.4±15.3）μg/L，明显较对照组的（29.1±2.4）mg/L和（118.3±14.4）μg/L低（P < 0.05）。观察组并发症发生率（5.7%）明显低于对照组（22.9%）（P < 0.05）。观察组术后1和2年生存率分别为85.8%和60.0%，与对照组的85.8%和57.1%比较，差异均无统计学意义（P > 0.05）。结论 腹腔镜辅助下远端胃癌根治术治疗进展期胃癌损伤小、出血量少、淋巴结清扫效果好、患者术后恢复快、炎症因子水平和并发症发生率低，且患者术后生存率与开腹手术无明显差异，值得临床中推广应用。

Abstract:

Objective To investigate the efficacy and safety of laparoscopic-assisted radical gastrectomy for distal gastric cancer in advanced gastric cancer.Methods 70 patients with advanced gastric cancer from June 2017 to June 2019 were selected as the research objects, and they were randomly divided into the control group (n = 35) and the observation group (n = 35); The control group were given radical laparotomy for radical gastric cancer, and the observation group were given laparoscopic-assisted radical gastrectomy for distal gastric cancer. The surgical indicators, postoperative recovery, serum inflammatory factor levels, postoperative complications, and survival rate were compared between the two groups.Results The incision length was (5.7 ± 0.8) cm in the observation group, which was significantly shorter than that of the control group (20.6 ± 1.9) cm; The intraoperative blood loss was (185.2 ± 68.6) mL in the observation group, which was significantly less than that of the control group (387.4 ± 120.5) mL (P < 0.05); The operation time was (275.3 ± 42.6) min in the observation group, which was significantly longer than that of the control group (201.5 ± 29.8) min (P < 0.05); The number of lymph node dissections in the observation group was (23.6 ± 5.8), compared with (24.2 ± 6.1) in the control group, and there was no significant difference (P > 0.05). The getting out of bed time, postoperative exhaust time and hospital stay in the observation group were (2.9 ± 0.9) d, (4.1 ± 0.7) d and (13.1 ± 2.8) d, which were significantly shorter than those in the control group (4.8 ± 1.2) d, (5.2 ± 1.1) d, (20.2 ± 4.3) d (P < 0.05). 3 days after operation, the C-reactive protein (CPR) and interleukin-6 (IL-6) of observation group were (18.3 ± 1.4) mg/L and (92.4 ± 15.3) μg/L, which were significantly lower than those of control group (29.1 ± 2.4) mg/L and (118.3 ± 14.4) μg/L (P < 0.05). The incidence of complications in the observation group (5.7%) was significantly lower than that in the control group (22.9%) (P < 0.05). The 1-year and 2-year survival rates in the observation group were 85.8% and 60.0%, respectively, and there was no significant difference compared with 85.8% and 57.1% in the control group (P > 0.05).Conclusion Laparoscopic-assisted radical gastrectomy for distal gastric cancer has less injury, less bleeding, and better lymph node dissection. The patient has a faster postoperative recovery, a lower level of inflammatory factors, and a lower incidence of complications. And the postoperative survival rate of the patients was not significantly different from that of the open surgery, it is worthy of popularization and application in clinic.