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目的:对比研究联合脾切除术与保留脾脏的淋巴结清扫术在进展期近端癌根治术中的临床疗效。方法:选取我院自2008年1月至2010年5月期间收治的进展期近端胃癌患者91例,根据患者意愿选择手术方式,所有病例均行全胃根治术,其中术中保留脾脏(total gastreotomy,TG)者共48例,联合脾切除(total gastreotomy plus splenectomy,TGS)者43例,比较两组患者手术时间、术中出血量、住院时间、术后并发症发生率、淋巴结清扫效果及远期无瘤生存率。结果:TG组所需手术时间长于TGS组(P<0.05),术后住院时间TGS组比TG组延长(P<0.05)。TGS组术后总体并发症发生率高于TG组(P<0.05),其中感染性并发症发生率具有统计学差异(P<0.05),2组患者再手术率和手术病死率无统计学差异(P>0.05)。2组患者在获取No.10和No.11淋巴结平均数量及No.10和No.11淋巴结转移率和转移度比较上,均无统计学差异(P>0.05)。2组术后1、3、5年无瘤生存率(DFS)均无统计学差异(P>0.05),Log-rank法检测两组DFS Kaplan-Meier生存率曲线图,未见显著性差异(P>0.05)。结论:在进展期近端胃癌根治术中,保留脾脏的淋巴结清扫术与联合脾脏切除术相比,可达到同样的淋巴结清扫效果,同时又降低了手术并发症的发生,在远期生存率上,2组并无统计学差异,遂推荐保留脾脏的淋巴结清扫术。
Objective: To compare the clinical efficacy of combined splenectomy and splenic lymph node dissection in the treatment of advanced proximal radical neoplasm. Methods: Ninety-one patients with advanced proximal gastric cancer admitted to our hospital from January 2008 to May 2010 were enrolled in this study. All patients underwent radical gastrectomy according to patients’ Forty-eight patients with gastreotomy (TG) and 43 patients with total gastreotomy plus splenectomy (TGS) were enrolled in this study. The operative time, intraoperative blood loss, length of hospital stay, postoperative complications and lymph node dissection were compared between the two groups Long-term disease-free survival. Results: The time required for operation in TG group was longer than that in TGS group (P <0.05). The postoperative hospital stay was longer in TGS group than in TG group (P <0.05). The overall incidence of postoperative complications in TGS group was higher than that in TG group (P <0.05), and the incidence of infectious complications was statistically significant (P <0.05). There was no significant difference in reoperation rate and operative mortality between the two groups (P> 0.05). There was no significant difference between the two groups in obtaining the average number of lymph nodes in No.10 and No.11 and in the rates of lymph node metastasis and metastasis in No.10 and No.11 (P> 0.05). No statistically significant difference was found in the 1, 3, 5 year disease-free survival (DFS) between the two groups (P> 0.05). The Kaplan-Meier survival rate was not significantly different between the two groups P> 0.05). CONCLUSIONS: In sparing radical resection of proximal gastric cancer, lymph node dissection with retained spleens achieves the same lymph node dissection compared with splenectomy, and at the same time reduces the incidence of surgical complications. As for the long-term survival rate , There is no statistical difference between the two groups, then recommended to keep the spleen lymph node dissection.