腹腔镜辅助下全胃切除术与近端胃切除术对进展期胃癌患者围术期指标及预后的影响
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摘要
目的探讨腹腔镜辅助下全胃切除术与近端胃切除术对进展期胃癌患者围术期指标及预后的影响。方法回顾性分析2015年3月至2016年3月本院收治的142例进展期胃癌患者的临床资料,依据治疗方法不同将其分为对照组(60例)和观察组(82例),对照组患者采用腹腔镜辅助下近端胃切除术,观察组患者采用腹腔镜辅助下全胃切除术,比较两组患者手术时间、术后肛门排气时间、术中出血量、住院天数、实验室指标(血红蛋白、总蛋白、白蛋白)、术后并发症及预后情况。结果观察组患者手术时间、术后肛门排气时间均较对照组明显延长(P_均<0.05),两组患者术中出血量、住院天数比较均无明显差异(P_均> 0.05);与治疗前比较,治疗后两组患者血红蛋白、总蛋白、白蛋白均明显升高(P_均<0.05),但观察组患者上述指标水平均显著低于对照组(P_均<0.05);观察组患者术后并发症发生率明显低于对照组(P <0.05);随访2年,两组患者生存率比较无显著差异(P> 0.05),观察组患者复发率显著低于对照组(P <0.05),术后随访生活质量显著优于对照组(P <0.05)。结论腹腔镜辅助下全胃切除术治疗进展期胃癌在改善预后方面较腹腔镜辅助下近端胃切除术更具优势,但前者的手术时间和术后肛门排气时间较长,且需注意改善患者术后营养状况。
Objective To investigate the influence of laparoscope assisted total gastrectomy and proximal gastrectomy on perioperative indexes and prognosis in patients with advanced gastric cancer. Method Retrospective analyzed the clinical data of 142 patients with advanced gastric cancer admitted to our hospital from March 2015 to March 2016. According to the different treatment methods, they were divided into control group(n = 60) and observation group(n = 82). Control group patients were treated by proximal gastrectomy with laparoscopic assistance, and observation group patients were treated by total gastrectomy with laparoscopic assistance. The operation time, postoperative anal exhaust time, intraoperative blood loss, hospital stay, laboratory parameters(hemoglobin, total protein, albumin), postoperative complication and prognosis were compared between the two groups.Result The operation time and postoperative anal exhaust time of observation group were signi?cantly longer than those of control group(P_(all)<0.05), but there were no signi?cant differences in intraoperative blood loss and hospital stay between the two groups(P_(all)>0.05). Compared with before treatment, hemoglobin, total protein and albumin were signi?cantly increased in the two groups after treatment(P_(all)< 0.05), but the above indicators levels in observation group were signi?cant lower that in control group(P_(all)< 0.05).The incidence of postoperative complications in observation group was lower than that in control group(P < 0.05). There was no signi?cant difference in 2-year follow-up survival rate between two groups(P > 0.05), but the recurrence rate in observation group was lower than that in control group(P < 0.05), the quality of life was signi?cantly better than that in control group(P < 0.05).Conclusion Laparoscope assisted total gastrectomy has more advantages over proximal gastrectomy for advanced gastric cancer in terms of improving prognosis. However, the operation time and postoperative anal exhaust time of the former are longer, and the patients postoperative nutritional status should be improved.
Objective To investigate the influence of laparoscope assisted total gastrectomy and proximal gastrectomy on perioperative indexes and prognosis in patients with advanced gastric cancer. Method Retrospective analyzed the clinical data of 142 patients with advanced gastric cancer admitted to our hospital from March 2015 to March 2016. According to the different treatment methods, they were divided into control group(n = 60) and observation group(n = 82). Control group patients were treated by proximal gastrectomy with laparoscopic assistance, and observation group patients were treated by total gastrectomy with laparoscopic assistance. The operation time, postoperative anal exhaust time, intraoperative blood loss, hospital stay, laboratory parameters(hemoglobin, total protein, albumin), postoperative complication and prognosis were compared between the two groups.Result The operation time and postoperative anal exhaust time of observation group were signi?cantly longer than those of control group(P_(all)<0.05), but there were no signi?cant differences in intraoperative blood loss and hospital stay between the two groups(P_(all)>0.05). Compared with before treatment, hemoglobin, total protein and albumin were signi?cantly increased in the two groups after treatment(P_(all)< 0.05), but the above indicators levels in observation group were signi?cant lower that in control group(P_(all)< 0.05).The incidence of postoperative complications in observation group was lower than that in control group(P < 0.05). There was no signi?cant difference in 2-year follow-up survival rate between two groups(P > 0.05), but the recurrence rate in observation group was lower than that in control group(P < 0.05), the quality of life was signi?cantly better than that in control group(P < 0.05).Conclusion Laparoscope assisted total gastrectomy has more advantages over proximal gastrectomy for advanced gastric cancer in terms of improving prognosis. However, the operation time and postoperative anal exhaust time of the former are longer, and the patients postoperative nutritional status should be improved.
引文
[1]左婷婷,郑荣寿,曾红梅,等.中国胃癌流行病学现状[J].中国肿瘤临床,2017,44(1):52-58.
[2]韩志鹏.新辅助化疗对中晚期胃癌根治术患者抑癌基因及血管内皮生长因子的影响[J].中国临床医生杂志,2017,45(3):70-76.
[3]樊华,高永涛,卢荣增,等.老年胃癌患者腹腔镜手术治疗效果及免疫球蛋白、T淋巴细胞亚群的变化观察[J].中国医刊,2018,53(12):60-64.
[4]Ge B,Zhao H,Rui L,et al.Influence of gum-chewing on postoperative bowel activity after laparoscopic surgery for gastric cancer:A randomized controlled trial[J].Medicine(Baltimore),2017,96(13):e6501.
[5]胡祥.日本《胃癌治疗指南》(第3版)解读[J].中国实用外科杂志,2010,30(1):25-30.
[6]李恒,杨晓晔.远端胃癌根治术后不同消化道重建手术对肠道菌落的影响[J].西南国防医药,2018,28(7):640-642.
[7]郑振东,韩涛.胃癌诊疗研究进展[J].临床军医杂志,2017,45(1):1-4.
[8]Lu C,Shan Z,Li C,et al.MiR-129 regulates cisplatinresistance in human gastric cancer cells by targeting P-gp[J].Biomed Pharmacother,2017,86:450-456.
[9]杨宏,张楠,崔明,等.腹腔镜辅助全胃切除术和近端胃切除术治疗食管胃结合部腺癌的疗效分析[J].中华消化外科杂志,2016,15(11):1062-1067.
[10]张治星,张金强,张升涛,等.进展期胃癌根治术消化道重建方式的选择[J].临床误诊误治,2017,30(3):113-116.
[11]江爱宗,李荣年,姜艳辉,等.根治性全胃切除与近端胃切除术治疗近端进展期胃癌的临床效果比较[J].实用癌症杂志,2018,33(10):65-68.
[12]蒋强.不同手术方式治疗弥漫型近端进展期胃癌患者的近期疗效及远期预后[J].医学临床研究,2018,35(4):654-656.
[13]代义壮,蔡长聚.进展期胃癌患者腹腔镜下全胃切除术后并发症发生的影响因素分析[J].中国肿瘤临床与康复,2018,25(2):143-145.
[14]胡子龙,张凯,胡时栋,等.腹腔镜辅助全胃切除与近端胃切除术治疗胃上部癌的围手术期临床疗效对比研究[J].腹部外科,2017,30(4):258-260,269.
[15]马健钧.胃上部癌患者全胃切除术和近端胃切除术治疗的效果观察[J].中国急救医学,2017,37(z1):193-194.
[16]李鹏,杨维桢.贲门癌根治性全胃切除术与根治性近端胃切除术的比较分析[J].中国医药导报,2017,14(20):113-116.
[17]刘江,王刚,赵健,等.全机器人下近端胃切除术治疗胃肠间质瘤[J].中华胃肠外科杂志,2017,20(3):294.
[18]王正.贲门癌根治性全胃切除术与根治性近端胃切除术的临床效果比较[J].中外医学研究,2017,15(33):175-176.
[19]常远.近端胃切除术和全胃切除术治疗食管胃结合部癌的效果对比分析[J].中国冶金工业医学杂志,2017,34(6):676-677.
[20]孙虎,范发明,陶国泉,等.近端胃切除与全胃切除在治疗近端胃癌中的疗效比较[J].现代生物医学进展,2016,16(15):2914-2917.
[2]韩志鹏.新辅助化疗对中晚期胃癌根治术患者抑癌基因及血管内皮生长因子的影响[J].中国临床医生杂志,2017,45(3):70-76.
[3]樊华,高永涛,卢荣增,等.老年胃癌患者腹腔镜手术治疗效果及免疫球蛋白、T淋巴细胞亚群的变化观察[J].中国医刊,2018,53(12):60-64.
[4]Ge B,Zhao H,Rui L,et al.Influence of gum-chewing on postoperative bowel activity after laparoscopic surgery for gastric cancer:A randomized controlled trial[J].Medicine(Baltimore),2017,96(13):e6501.
[5]胡祥.日本《胃癌治疗指南》(第3版)解读[J].中国实用外科杂志,2010,30(1):25-30.
[6]李恒,杨晓晔.远端胃癌根治术后不同消化道重建手术对肠道菌落的影响[J].西南国防医药,2018,28(7):640-642.
[7]郑振东,韩涛.胃癌诊疗研究进展[J].临床军医杂志,2017,45(1):1-4.
[8]Lu C,Shan Z,Li C,et al.MiR-129 regulates cisplatinresistance in human gastric cancer cells by targeting P-gp[J].Biomed Pharmacother,2017,86:450-456.
[9]杨宏,张楠,崔明,等.腹腔镜辅助全胃切除术和近端胃切除术治疗食管胃结合部腺癌的疗效分析[J].中华消化外科杂志,2016,15(11):1062-1067.
[10]张治星,张金强,张升涛,等.进展期胃癌根治术消化道重建方式的选择[J].临床误诊误治,2017,30(3):113-116.
[11]江爱宗,李荣年,姜艳辉,等.根治性全胃切除与近端胃切除术治疗近端进展期胃癌的临床效果比较[J].实用癌症杂志,2018,33(10):65-68.
[12]蒋强.不同手术方式治疗弥漫型近端进展期胃癌患者的近期疗效及远期预后[J].医学临床研究,2018,35(4):654-656.
[13]代义壮,蔡长聚.进展期胃癌患者腹腔镜下全胃切除术后并发症发生的影响因素分析[J].中国肿瘤临床与康复,2018,25(2):143-145.
[14]胡子龙,张凯,胡时栋,等.腹腔镜辅助全胃切除与近端胃切除术治疗胃上部癌的围手术期临床疗效对比研究[J].腹部外科,2017,30(4):258-260,269.
[15]马健钧.胃上部癌患者全胃切除术和近端胃切除术治疗的效果观察[J].中国急救医学,2017,37(z1):193-194.
[16]李鹏,杨维桢.贲门癌根治性全胃切除术与根治性近端胃切除术的比较分析[J].中国医药导报,2017,14(20):113-116.
[17]刘江,王刚,赵健,等.全机器人下近端胃切除术治疗胃肠间质瘤[J].中华胃肠外科杂志,2017,20(3):294.
[18]王正.贲门癌根治性全胃切除术与根治性近端胃切除术的临床效果比较[J].中外医学研究,2017,15(33):175-176.
[19]常远.近端胃切除术和全胃切除术治疗食管胃结合部癌的效果对比分析[J].中国冶金工业医学杂志,2017,34(6):676-677.
[20]孙虎,范发明,陶国泉,等.近端胃切除与全胃切除在治疗近端胃癌中的疗效比较[J].现代生物医学进展,2016,16(15):2914-2917.