腹腔镜保脾脾门淋巴结清扫术在局部进展期胃上部癌根治术中的安全性

摘要

Objective To investigate the effect of laparoscopic splenectomy and splenic lymph node dissection in the treatment of advanced gastric cancer after radical resection.Methods 118 cases of advanced gastric cancer after radical surgery patients were divided into 2 groups,the control group received total gastrectomy and splenic hilar lymph node dissection,the ob-servation group received laparoscopic spleen preserving splenic hilar lymph node dissection,observed the differences in prognosis and complications of different methods.Results The operation time,intraoperative blood loss,blood transfusion,the first semi liquid time and hospitalization time in the observation group were superior to the control group,there had significant differences between the 2 groups(P<0.05),and the first ambulation time,anal exhaust time,the first liquid time of the 2 groups had no sig-nificant difference(P>0.05).Postoperative complications of the control group was 18.63%,and the observation group was 8.46%,the observation group was significantly lower than the control group,there was significant difference between the 2 groups (P<0.05);in the control group,before discharge,6-,12-,18-,24-and 30-months survival rates were 96.61%,88.14%, 77.97%,67.8%,57.63%,45.76%respectively.and the observation group were 100%,91.53%,81.36%,69.49%,59.32%, 47.46%respectively,the difference between the 2 groups was not significant(P>0.05).Conclusion Laparoscopic spleen pre-serving splenic hilar lymph node dissection can improve the curative effect of radical resection of advanced gastric cancer and re -duce the incidence of complications.%目的 探讨腹腔镜保脾脾门淋巴结清扫对进展期胃上部癌根治术后疗效的影响.方法 选取118例进展期胃上部癌根治术患者为研究对象,分成2组,对照组予全胃切除术并脾门淋巴结清扫,观察组行腹腔镜保脾脾门淋巴结清扫术,观察不同方法在预后和并发症等方面差异性.结果 观察组在手术时间、术中出血量、输血、首次进半流质时间、住院时间上显著优于对照组,两组比较差异显著(P<0.05),而首次下床活动时间、肛门排气时间、首次进流质时间相近,无差异性(P>0.05);对照组术后并发症发生率为18.63%,观察组为8.46%,观察组显著低于对照组,两组比较差异显著(P<0.05);对照组出院前、术后6个月、12个月、18个月、24个月、30个月生存率分别为96.61%、88.14%、77.97%、67.8%、57.63%、45.76%.观察组相对应分别为100%、91.53%、81.36%、69.49%、59.32%、47.46%,两组比较差异不显著(P>0.05).结论 腹腔镜保脾脾门淋巴结清扫能提高进展期胃上部癌根治术后疗效,降低并发症发生率.