腹腔镜辅助保留胰腺和脾脏的全胃切除术与开放性全胃切除术治疗胃癌的比较。
Laparoscopy-assisted pancreas- and spleen-preserving total gastrectomy for gastric cancer as compared with open total gastrectomy.
机构信息
Department of Surgery, Kitasato University School of Medicine, 2-1-1 Asamizodai, Sagamihara, Kanagawa, 228-8520, Japan.
出版信息
Surg Endosc. 2009 Nov;23(11):2416-23. doi: 10.1007/s00464-009-0371-0. Epub 2009 Mar 6.
BACKGROUND
Laparoscopy-assisted total gastrectomy (LATG) is not widely used for the treatment of gastric cancer located in the upper or middle third of the stomach. To assess the safety and usefulness of LATG, we compared the outcomes of LATG with those of open total gastrectomy (OTG).
METHODS
From July 2004 to July 2007, we performed pancreas- and spleen-preserving total gastrectomy with D1 + beta or D2 lymph-node dissection and Roux-en-Y reconstruction in 74 patients with cancer located in the upper or middle third of the stomach. Of these patients, 30 underwent LATG (LATG group) and 44 underwent OTG (OTG group). Short-term outcomes were compared between the groups.
RESULTS
Operation time was significantly longer in the LATG group than in the OTG group (313 min vs. 218 min, p < 0.001). Blood loss (134 g vs. 407 g, p < 0.001) and the rate of the use of analgesics (6.8 times vs. 11.8 times, p < 0.05) were significantly lower, and postoperative hospital stay was significantly shorter in the LATG group than in the OTG group (13.5 days vs. 18.2 days, p < 0.05). The LATG group had better hematologic and serum chemical profiles, including white-cell counts, C-reactive protein levels, total protein levels, and albumin levels, as well as lower rate of postoperative body-weight loss. The number of dissected lymph nodes (43.2 vs. 51.2, p = 0.098) and the rate of postoperative complications (20.0% vs. 27.3%, p = 0.287) were similar in the groups. However, major complications such as anastomotic leakage, abdominal abscess, and pancreatic leakage occurred in six patients (13.6%) in the OTG group, but in none of the patients in the LATG group.
CONCLUSIONS
LATG is associated with less severe complications and better postoperative quality of life than OTG. We believe that LATG is a safe, useful, and less invasive alternative for the treatment of gastric cancer located in the upper or middle third of the stomach.
背景
腹腔镜辅助全胃切除术（LATG）在治疗胃中上三分之一部位的胃癌中并未广泛应用。为评估 LATG 的安全性和实用性，我们将 LATG 的结果与开腹全胃切除术（OTG）的结果进行了比较。
方法
自 2004 年 7 月至 2007 年 7 月，我们对 74 例胃中上三分之一部位癌症患者进行了保留胰腺和脾脏的全胃切除术，并行 D1 +β或 D2 淋巴结清扫和 Roux-en-Y 重建。其中 30 例患者接受 LATG（LATG 组），44 例患者接受 OTG（OTG 组）。比较两组患者的短期结果。
结果
LATG 组的手术时间明显长于 OTG 组（313 分钟 vs. 218 分钟，p < 0.001）。LATG 组的出血量（134 克 vs. 407 克，p < 0.001）和镇痛药使用率（6.8 次 vs. 11.8 次，p < 0.05）均显著较低，术后住院时间明显短于 OTG 组（13.5 天 vs. 18.2 天，p < 0.05）。LATG 组的血液学和血清化学指标更好，包括白细胞计数、C 反应蛋白水平、总蛋白水平和白蛋白水平，以及术后体重下降率更低。两组淋巴结清扫数目（43.2 枚 vs. 51.2 枚，p = 0.098）和术后并发症发生率（20.0% vs. 27.3%，p = 0.287）相似。但是，OTG 组有 6 例（13.6%）患者发生吻合口漏、腹腔脓肿和胰腺漏等严重并发症，而 LATG 组无此类并发症。
结论
与 OTG 相比，LATG 术后并发症较轻，生活质量较高。我们认为，LATG 是治疗胃中上三分之一部位胃癌的一种安全、有效、微创的替代方法。
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