腹腔镜全胃切除术与近端胃切除术治疗近端胃癌的临床研究

摘要

目的:比较腹腔镜全胃切除术与近端胃切除术治疗近端胃癌的临床效果.方法:回顾分析57例近端胃癌患者的临床资料,其中26例行腹腔镜根治性近端胃癌切除术(近端组),31例行腹腔镜根治性全胃切除术(全胃组).两组患者分别于入院当天及术后应用视觉模拟评分法(visual analogue scale／score,VAS)、焦虑自评量表(self－rating anxiety scale,SAS)、抑郁自评量表(self－rating depression scale ,SDS)进行疼痛感与负性情绪评价并随访.结果:术前两组患者VAS、SAS、SDS评分差异均无统计学意义(P＜0.05);术后近端组VAS评分低于全胃组(P＜0.05),SAS、SDS评分高于全胃组(P＜0.05).近端组术后反流发生率高于全胃组(P＜0.05),贫血、体重减轻等并发症发生率低于全胃组(P＜0.05).两组无复发生存时间分别为(23.5 ±3.3)个月与(33.0±2.1)个月,差异有统计学意义(P＜0.05);肿瘤进展率分别为30.8%与6.5%,差异有统计学意义(P＜0. 05).结论:腹腔镜近端胃切除术可降低患者贫血、体重减轻等并发症发生率,但相较腹腔镜全胃切除术具有更高的反流发生率,影响焦虑、抑郁情绪.临床中应根据患者情况与要求个体化选择手术方式.%Objective:To compare the clinical effect of laparoscopic total gastrectomy and proximal gastrectomy for proximal gastric cancer.Methods:Clinical data of fifty－seven patients with proximal gastric cancer were retrospectively analyzed ,26 patients un－derwent laparoscopic proximal radical gastrectomy (proximal group) and other 31 underwent total gastrectomy (total group).The visual analogue scale (VAS),self－rating anxiety scale (SAS) and self－rating depression scale (SDS) were used on the day of admission and after surgery for the two groups to evaluate pain and negative emotions ,and follow－up was performed after the discharge.Results:There was no significant difference in VAS ,SAS and SDS scores between two groups before operation (P＜0.05).Postoperative VAS scores and the incidence of complications such as anemia and weight loss of proximal group were significantly lower than those of the total group (P＜0.05),while the level of anxiety and depression ,incidence of postoperative reflux were significantly higher than those of the total group (P＜0.05).Significant differences were also found in the recurrence－free survival time [(23.5±3.3) months vs.(33.0±2. 1) months] and the tumor progression rate (30.8%vs 6.5%) between the two groups respectively.Conclusions: Laparoscopic proxi－mal gastrectomy can reduce the incidence of complications such as anemia and weight loss .However,the incidence of reflux is higher than that of total resection w,hich affects anxiety and depression.The surgical methods should be selected according to the patient＇s con－dition and individual choice.