摘要
目的 研究腹腔镜胃癌根治术(LTG)与托出式脾门入路淋巴结清扫(TLND)联合治疗胃癌的效果.方法以前瞻性分析为法,选取2019年1至12月江苏省肿瘤医院收治入院的80例胃癌患者为研究对象,按照随机数字表法将其分为两组:观察组(n=43)与对照组(n=37).对照组实施开腹手术联合托出式脾门TLND,观察组实施LTG与托出式脾门TLND.比较两组手术近期疗效(手术时间、术中出血量、总淋巴结清扫数量、脾门淋巴结检出数量、腹部切口长度、首次流质食物摄入时间以及术后住院时间)、生活质量、肿瘤学指标[癌胚抗原、甲胎蛋白、糖类抗原(CA)199、CA724]、术后并发症、远期疗效.结果 观察组的手术时间为(243.16±47.51)min,长于对照组[(193.42±39.85)min],术中出血量为(114.78±60.84)mL,少于对照组[(201.46±70.49)mL],腹部切口长度、首次流质食物摄入时间以及术后住院时间分别为(6.33±1.15)cm、(5.19±2.31)d、(11.92±2.15)d,均短于对照组[(17.52±4.85)cm、(7.45± 2.62)d、(14.99±3.49)d],总淋巴结清扫数量、脾门淋巴结检出数量分别为(25.75±4.31)、(5.23±1.43)枚,均高于对照组[(22.23±3.44)、(3.41±1.62)枚],差异均有统计学意义(P＜0.05).手术后1个月,两组患者生活质量评分中主观症状、社会活动功能、生理功能、心理情绪以及生存质量指数(GLQI)总分均下降,且观察组分别为(60.41±4.75)、(10.65±1.64)、(17.51±3.21)、(12.31±1.02)、(103.39±4.19)分,均明显低于对照组[(66.98±5.13)、(12.28±1.56)、(19.19±3.35)、(13.88±1.34)、(113.27±4.98)分],差异均有统计学意义(P＜0.05).手术后1个月,两组患者血清癌胚抗原、甲胎蛋白、CA199、CA724水平均较手术前降低,且观察组血清癌胚抗原、甲胎蛋白、CA199、CA724水平分别为(10.87±2.33)μg/L、(10.42±5.41)ng/mL、(40.16±7.42)U/L、(6.31±1.03)U/mL,均明显低于对照组[(15.78± 2.84)μg/L、(16.49±4.87)ng/mL、(60.46±10.48)U/L、(8.42±1.09)U/mL],差异均有统计学意义(P＜0.05).观察组术后并发症总发生率为4.65％,低于对照组(24.32％),差异有统计学意义(P＜0.05).观察组3年总生存率以及无病生存率分别为93.02％、69.77％,均高于对照组(72.97％、45.95％),差异均有统计学意义(P＜0.05).结论胃癌患者开展LTG与托出式脾门TLND联合治疗效果显著,对于术后康复与生活质量而言有明显改善作用,降低术后并发症,减轻血清内肿瘤因子水平,且3年的总生存率、无瘤生存率较高.
Abstract
Objective To investigate the efficacy of laparoscopic radical gastrectomy(LTG)and propulsive hilar splenic approach thera-peutic lymph node dissection(TLND)in the treatment of gastric cancer.Methods In a prospective analysis,80 gastric cancer patients admitted to Jiangsu Cancer Hospital from January to December 2019 were selected as the study subjects.They were randomly divided into two groups accord-ing to the random number table method:the observation group(n=43)and the control group(n=37).The control group received laparotomy combined with propulsive hilus TLND,and the observation group received LTG and propulsive hilus TLND.The short-term efficacy(operation time,intraoperative blood loss,total number of lymph node dissection,number of splenic lymph node detections,length of the abdominal incision,time of first fluid food intake,and postoperative hospitalization time),quality of life,oncological indicators[carcinoembryonic antigen,alpha fe-toprotein,carbohydrate antigen(CA)199,CA724],postoperative complications,and long-term efficacy of the two groups were compared.Results The operation time of the observation group was(243.16±47.51)min,which was longer than that of the control group[(193.42± 39.85)min],and the intraoperative blood loss was(114.78±60.84)mL,which was less than that of the control group[(201.46±70.49)mL],the length of the abdominal incision,the time of first liquid food intake,and the postoperative hospitalization time were(6.33±1.15)cm,(5.19±2.31)d,and(11.92±2.15)d,which were shorter than those in the control group[(17.52±4.85)cm,(7.45±2.62)d,(14.99 ±3.49)d],the total number of lymph node dissection,number of splenic lymph node detections in the splenic hilar were(25.75±4.31)and(5.23±1.43),respectively,which were higher than in the control group[(22.23±3.44)and(3.41±1.62)],and the differences were sta-tistically significant(P＜0.05).One month after surgery,the subjective symptoms,social activity function,physiological function,psychologi-cal emotion,and total score of Gastrointestinal Life Quality Index(GLQI)in two groups were lower than those before operation,the scores of in the observation group were(60.41±4.75),(10.65±1.64),(17.51±3.21),(12.31±1.02)and(103.39±4.19)points,which were signifi-cantly lower than those in the control group[(66.98±5.13),(12.28±1.56),(19.19±3.35),(13.88±1.34),(113.27±4.98)points],and the differences were statistically significant(P＜0.05).One month after operation,the serum levels of carcinoembryonic antigen,alpha-fetoprotein,CA199 and CA724 in two groups were lower than those before operation,the levels of carcinoembryonic antigen,alpha-feto-protein(10.42±5.41)ng/mL,CA1 99 and CA724 in the observation group were(10.82.33)μg/L,(40.16±7.42)U/L,(6.31±1.03)U/mL,which were significantly lower than those in the control group[(15.78±2.84)μg/L,(16.49±4.87)ng/mL,(60.46±10.48)U/L,(8.42±1.09)U/mL],the differences were statistically significant(P＜0.05).The total incidence of postoperative complications in the obser-vation group was 4.65％,which was lower than that in the control group,and the difference was statistically significant(P＜0.05).The 3-year overall survival rate and tumor-free survival rate in observation group were 93.02％,69.77％,which were higher than those in control group,the differences were statistically significant(P＜0.05).Conclusion The combined treatment of LTG and profligate hilum TLND has significant effects on postoperative rehabilitation and quality of life,reducing postoperative complications and reducing the level of serum tumor fac-tors in patients with gastric cancer,and the 3-year overall and tumor-free survival rates are relatively high.
维普
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