完整胃系膜切除在胃癌根治术中的临床疗效

Clinical efficacy of complete mesogaster excision in the radical gastrectomy for gastric cancer

    摘要
  • 摘要: 目的:探讨采用完整胃系膜切除在胃癌根治术中的临床疗效。
    方法:回顾性分析2011年1月至2012年12月哈尔滨医科大学附属第一医院收治的100例行胃癌根治术患者的临床资料，采用完整胃系膜切除的方法行D2胃癌根治术，从完整胃系膜切除手术时间、术中出血量、所获淋巴结数目、术后肛门排气时间、术后引流量、术后住院时间6个方面评价手术的质量。采用电话和门诊方式进行随访，随访时间截至2014年5月。
    结果:患者均成功施行完整胃系膜切除胃癌根治术，手术时间为(118±34)min(90～160 min)，术中出血量为(80±25)mL(45～135 ml)，所获完整淋巴结数目为(38±10)枚(25～52枚)，术后肛门排气时间为(3.0±1.2)d(1.5～4.5 d)，术后引流量为(62±15)mL(15～85 mL)，术后住院时间为(7.0±1.5)d(4.0～11.5 d)。术后病理学检查结果：高分化腺癌36例，中低分化腺癌38例，低分化腺癌17例，印戒细胞癌9例。术后发生胃瘫3例，腹壁切口愈合不良2例，十二指肠残端瘘2例，胰瘘1例，均经保守治疗后痊愈。所有患者获得随访，平均随访时间为25.6个月(17.6～39.2个月)，肿瘤无复发。
    结论:完整胃系膜切除胃癌根治术安全有效，手术并发症发生率低，远期疗效满意。

     

    Abstract: Objective:To investigate the clinical efficacy of complete mesogaster excision in the radical gastrectomy for gastric cancer.Methods:The clinical data of 100 patients with distal gastric cancer who were admitted to the First Affiliated Hospital of Harbin Medical University from January 2011 to December 2012 were retrospectively analyzed. All the patients underwent complete mesogaster excision in D2 radical gastrectomy for gastric cancer. The operation quality was evaluated according to operation time, volume of intraoperative blood loss, mean number of lymph nodes dissected, time to flatus, volume of drainage and duration of postoperative hospital stay. Patients were followed up by outpatient examination and telephone interview till May 2014. Results:Complete mesogaster excision in the radical gastrectomy for gastric cancer was successfully carried out on all the 100 patients. The operation time, volume of intraoperative blood loss, mean number of lymph nodes dissected, time to flatus, volume of drainage and duration of postoperative hospital stay were (118±34)minutes (range, 90-160 minutes), (80±25)mL (range, 45-135 mL), 38±10 (range, 25-52), (3.0±1.2)days (range, 1.5-4.5 days), (62±15)mL (range, 15-85 mL) and (7.0±1.5)days (range, 4.0-11.5 days), respectively. According to the postoperative pathological results, there were 36 patients with high differentiated gastric carcinoma, 38 with moderate and/or low differentiated gastric carcinoma, 17 with low differentiated gastric carcinoma and 9 with signet ring cell carcinoma. After operation, 3 patients had gastroplegia, 2 with poor healing of abdominal incision, 2 with duodenal stump fistula, 1 with pancreatic fistula, and all of them were cured by conservative treatment. All the 100 patients were followed up for a mean time of 25.6 months (range, 17.6-39.2 months). There was no tumor recurrence. Conclusions:Complete mesogaster excision in the radical gastrectomy for gastric cancer is safe and feasible, with the advantage of minimal trauma, low morbidity and quick recovery during the follow up.

     

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