腹腔镜胃癌根治术中肝总动脉后入路8p组淋巴结清扫的临床效果研究

Efficacy of common hepatic artery posterior approach for dissection of 8p group lymph node in laparoscopic radical gastrectomy for gastric cancer

摘要:

目的 探讨腹腔镜胃癌根治术中联合肝总动脉后入路行8p组淋巴结清扫的安全性、可行性和短期预后。方法 回顾性分析2018年1月－2021年9月在该院胃肠外科行腹腔镜胃癌根治术的560例患者的临床资料。按照实际手术方式分为两组，观察组（182例）行腹腔镜胃癌根治术联合肝总动脉后入路8p组淋巴结清扫，对照组（378例）行标准腹腔镜胃癌根治术。比较两组患者手术相关指标，分析8p组淋巴结与胰腺上区淋巴结转移的相关性，以及8p组淋巴结转移对预后的影响。结果 观察组手术时间明显长于对照组，淋巴结检出总数多于对照组，差异均有统计学意义（P < 0.05）；两组患者术后住院时间比较，差异无统计学意义（P > 0.05）。观察组术后肿瘤N₂分期和N₃分期占比高于对照组，差异有统计学意义（P < 0.05）。两组患者术中门静脉损伤、肝总动脉损伤、术后创伤性胰腺炎、胰漏、淋巴漏和腹腔出血等并发症的发生率比较，差异均无统计学意义（P > 0.05）。观察组中有23例（12.64%）发生8p组淋巴结转移，单因素分析和多因素Logistic回归模型分析均提示，8p组淋巴结转移与胰腺上区的7、8a和11p组淋巴结转移相关。术后随访3～66个月，中位随访时间49个月，亚组分析结果显示，8p组淋巴结阳性组的1和3年生存率分别为78.20%和39.10%，阴性组分别为89.90%和76.10%，差异均有统计学意义（P < 0.05）。结论 胃癌患者有一定的8p组淋巴结转移率，胰腺上区7、8a和11p组淋巴结转移是8p组淋巴结转移的危险因素，清扫8p组淋巴结的胃癌患者，具有更高的淋巴结转移度分布，8p组淋巴结转移是影响胃癌患者预后的重要因素。腹腔镜胃癌根治术联合肝总动脉后入路行8p组淋巴结清扫，可提高淋巴结清扫效果，且不增加手术副损伤和术后并发症，是安全和可行的。

Abstract:

Objective To explore the safety, feasibility and short-term prognosis of laparoscopic radical gastrectomy for gastric cancer combined with 8p lymph node group dissection through the common hepatic artery posterior approach.Methods Retrospective analysis of the clinical data of 560 patients undergoing laparoscopic radical gastrectomy for gastric cancer from January 2018 to September 2021. According to the actual surgical methods, they were divided into two groups. The observation group (182 cases) received laparoscopic radical gastrectomy for gastric cancer combined with lymph node 8p dissection through the common hepatic artery posterior approach, while the control group received standard laparoscopic radical gastrectomy for gastric cancer. Compare the surgery-related indicators of the two groups, and analyze the correlation between lymph nodes in the 8p group and lymph node metastasis in the upper pancreatic region, and the prognostic effect of 8p group lymph node metastasis was analyzed.Results The observation group had longer surgical time and more total lymph node detection than those of the control group, with a statistically significant difference (P < 0.05). The proportion of postoperative tumor N₂ and N₃ staging in the observation group was higher than that in the control group, with a statistically significant difference (P < 0.05), but no significant difference was observed in the length of postoperative hospital stay between the two groups (P > 0.05). There was no statistically significant difference in complications such as intraoperative portal vein injury, common hepatic artery injury, postoperative traumatic pancreatitis, pancreatic leakage, lymphatic leakage, and abdominal bleeding. 23 cases (12.64%) in the observation group had lymph node metastasis in the 8p group. Univariate analysis and multivariate Logistic regression analysis showed that lymph node metastasis in the 8p group was associated with lymph node metastasis in the 7, 8a, and 11p groups of the upper pancreatic region. After 3~66 months of follow-up (median follow-up time was 49 months), the 1 and 3 year survival rates of the 8p node-positive group were 78.20% and 39.10%, respectively, the negative group was 89.90% and 76.10%, the difference was statistically significant (P < 0.05).Conclusion Gastric cancer patients have a certain rate of lymph node 8p group metastasis. Lymph node metastasis in the 7, 8a and 11p group of the suprapancreatic region is a risk factor for 8p group lymph node metastasis, 8p group lymph node dissection has a higher degree distribution of lymph node metastasis in patients with gastric cancer, and lymph node 8p metastasis is an important prognostic factor for gastric cancer patients. Laparoscopic radical gastrectomy for gastric cancer combined with 8p group lymph node dissection through the common hepatic artery posterior approach can improve the effectiveness of lymph node dissection without increasing surgical side injuries and postoperative complications. It is safe and feasible.