腹腔鏡下局部進展期胃上部癌的淋巴結清掃的效果分析

張磊 劉云庚 劉 茜 方傳發 夏來陽 易建中

摘要：目的? 對比分析腹腔鏡輔助與開腹手術在進展期胃上部癌中淋巴結清掃的效果。方法? 選取2015年5月～2018年12月在我科治療的44例進展期胃上部癌患者作為研究對象，均行淋巴清掃，根據不同手術方式分為腹腔鏡組26例和開腹組18例，比較兩組淋巴結清掃數目、術中出血量、手術時間、恢復進食時間、肛門排氣時間、術后并發癥及1年生存率。結果? 兩組術中出血量、清掃淋巴結數目方面，差異無統計學意義（P>0.05）。腹腔鏡組手術時間、恢復進食時間、肛門排氣時間短于開腹組（P<0.05）。腹腔鏡組術后并發癥發生率為7.69%，與開腹組的11.11%比較，差異無統計學意義（P>0.05）。兩組患者手術后均隨診6～24個月，平均16個月，腹腔鏡組術后1年生存率為80.77%，與開腹組83.33%比較，差異無統計學意義（P>0.05）。結論? 腹腔鏡輔助對進展期胃上部癌淋巴結清掃與開腹手術的淋巴結清掃效果相當，但在臨床療效方面具有微創優勢并且有利于患者術后恢復，促進患者康復，值得臨床應用。

關鍵詞：胃上部癌;進展期;腹腔鏡;淋巴結清掃

中圖分類號：R572;R656.6+1? ? ? ? ? ? ? ? ? ? ? ? ? ?文獻標識碼：B? ? ? ? ? ? ? ? ? ? ? ? ? ?DOI：10.3969/j.issn.1006-1959.2020.19.062

文章編號：1006-1959（2020）19-0188-02

Abstract：Objective? To compare and analyze the effect of laparoscopic assisted and open surgery in lymph node dissection in advanced upper gastric cancer.Methods? A total of 44 patients with advanced upper gastric cancer treated in our department from May 2015 to December 2018 were selected as the research objects. All patients underwent lymphatic dissection. According to different surgical methods， they were divided into 26 cases in the laparoscopic group and 18 cases in the open group.Compare the number of lymph node dissection， intraoperative blood loss， operation time， time to recover from eating， time of anal exhaust， postoperative complications， and 1-year survival rate between the two groups.Results? There was no significant difference in the amount of blood loss and the number of lymph nodes dissected between the two groups （P>0.05）. The laparoscopic group's operation time， recovery time， and anal exhaust time were shorter than those of the open group（P<0.05）. The incidence of postoperative complications in the laparoscopic group was 7.69%， compared with 11.11% in the open group， the difference was not statistically significant （P>0.05）. The patients in both groups were followed up for 6 to 24 months after surgery， with an average of 16 months. The 1-year survival rate in the laparoscopic group was 80.77%， which was not statistically significant compared with 83.33% in the open group （P>0.05） . Conclusion? Laparoscopy-assisted lymph node dissection for advanced upper gastric cancer had the same effect as open surgery， but it had minimally invasive advantages in clinical efficacy and was beneficial to postoperative recovery and promotes patient recovery. It was worthy of clinical application.