应用铂类药物的新辅助化疗联合腹腔镜切除治疗T1期胃癌的临床效果观察

摘要

Objective To investigate the effect of platinum based neoadjuvant chemotherapy (NACT)combined with laparoscopic resection in treating stage T1 gastric cancer.Methods Totally 240 patients with stage T1 gastric cancer from January 2007 to January 2014 received platinum based NACT, then were divided into laparoscopy surgery group (136 cases) and open surgery group (104 cases) according to the patient selection.The lymph node cleaning scope, distance from tumor to cut edge, operation duration, intraoperative blood loss, recovery time of gastrointestinal function, postoperative hospitalization duration and the incidence of complications in short term were compared between groups.Results The objective effective rate was 57.9％(139/240) and the clinical benefit rate was 89.2％ (214/240) after NACT.The operation duration in laparoscopy surgery group was significantly longer, the intraoperative blood loss, recovery time of gastrointestinal function and postoperative hospitalization duration were significantly less/shorter than those in open surgery group [(196±20) minvs (168±19) min, (99±45) mlvs (177±50) ml, (2.8±0.6) dvs (3.3±0.7) d,(7.7 ± 0.9) d vs (15.2 ± 1.6) d] (P ＜ 0.05);the lymph node cleaning scope, distance from tumor to cut edge and incidence of postoperative complications were not significantly different between groups (P ＞ 0.05).Conclusion Laparoscopic resection has the same lymph node cleaning scope compared with open surgery in treating T1 stage gastric cancer after platinum drugs based NACT, with less intraoperative bleeding and faster recovery.%目的 探讨应用铂类药物的新辅助化疗(NACT)联合腹腔镜切除治疗T1期胃癌的临床效果.方法 2007年1月至2014年1月广东省江门市中心医院病房收治的240例T1期胃癌患者在应用铂类药物的NACT治疗后,按照患者选择分为腹腔镜手术组(136例)和开腹手术组(104例),对比2组患者的术中淋巴结清扫范围、肿瘤距切缘距离、手术所需时间、术中出血量、术后胃肠功能恢复时间、术后住院天数和近期并发症的发生率.结果 240例患者接受铂类药物的NACT后客观有效率为57.9％(139/240),临床的获益率为89.2％ (214/240).腹腔镜手术组手术所需时间长于开腹手术组,术中出血量、术后胃肠功能恢复时间、术后住院时间均小于开腹手术组,差异有统计学意义[(196±20) min比(168±19)min、(99±45) ml比(177±50) ml、(2.8±0.6)d比(3.3±0.7)d、(7.7±0.9)d比(15.2±1.6)d,P＜0.05],而淋巴结清扫范围、肿瘤距切缘距离以及术后并发症的发生率差异均无统计学意义(P＞0.05).结论 应用铂类药物的NACT联合腹腔镜切除治疗T1期胃癌淋巴结清扫范围与联合开腹手术相似,术中出血少、术后恢复快.