开腹与腹腔镜脾门淋巴结清扫对进展期胃癌的近期疗效观察及生存分析

目的探讨开腹与腹腔镜脾门淋巴结清扫对进展期胃癌的近期疗效及生存情况。方法  选择2017年1月至2019年6月南通市中医院收治的86例拟行根治性全胃切除术的进展期胃癌为研究对象，对照组采用开腹脾门淋巴结清扫，研究组采用腹腔镜脾门淋巴结清扫。比较两组术中、术后情况、术后7 d并发症发生情况及无进展生存时间。结果两组总手术时间、肿瘤大小、No.10淋巴结清扫时间。No.10淋巴结清扫数目、淋巴结总清扫数目比较差异无统计学意义（P＞0.05），研究组总出血量、清扫No.10淋巴结出血量低于对照组（P＜0.05）；两组引流管拔出时间、住院费用比较差异无统计学意义（P＞0.05），研究组住院时间、术后首次排便时间、胃管拔出时间、术后首次排气时间均短于对照组（P＜0.05）；两组术后7 d内并发症总发生率比较差异无统计学意义（P＞0.05）；随访3年，对照组失访1例，研究组失访2例，随访率为96.51%，研究组与对照组无进展生存时间分别为22.35个月（95%CI：12.39～28.41）、21.73个月（95%CI：9.25～24.52），两组无进展生存曲线比较，差异无统计学意义（P＞0.05）。结论在进展期胃癌根治性全胃切除术中，腹腔镜脾门淋巴结清扫近期效果良好，安全可行，且预后良好。

Short-term curative effect observation and survival analysis of laparotomy and laparoscopic splenic hilar lymph node dissection for advanced gastric cancer

Objective To investigate the short-term efficacy and survival of open and laparoscopic splenic hilar lymph node dissection for advanced gastric cancer. Methods Eighty-six patients with advanced gastric cancer undergoing radical total gastrectomy who were admitted to the hospital from January 2017 to June 2020 were selected as the research objects. They were divided into 2 groups by random number table, with 43 cases in each group. Both groups underwent radical total gastrectomy, the control group underwent open splenic hilar lymph node dissection, and the study group underwent laparoscopic splenic hilar lymph node dissection. The intraoperative and postoperative conditions, the occurrence of complications and progression-free survival time at 7 days after operation were compared between the two groups. ResultsThere were no significant difference in the total operation time, tumor size, No.10 lymph node dissection time, No.10 lymph node dissection number, and total lymph node dissection number between the two groups (P>0.05).The total bleeding volume of the study group and the bleeding volume of No.10 lymph node dissection were lower than those of the control group (P＜0.05). There were no statistically significant difference between the two groups in the drainage tube removal time and hospitalization expenses (P>0.05). The study group’s hospital stay, postoperative first defecation time, gastric tube removal time, and first postoperative exhaust time were all shorter than those of the control group (P＜0.05). There were no significant difference in the total incidence of complications within 7 days after the operation between the two groups (P>0.05). Follow-up for 1 year, 1 case in each group was lost, the follow-up rate was 97.59%. The progression-free survival time of the study group and control group was 7.12 months (95%CI4.17-11.08) and 5.96 months (95%CI3.96-10.85). There was no statistically significant difference in the progression-free survival curves between the two groups (P>0.05). Conclusion In radical total gastrectomy for advanced gastric cancer, laparoscopic splenic hilar lymph node dissection has good short-term results, is safe and feasible, and has a good prognosis.