标题：腹腔镜胃癌D2顺向式淋巴结清扫手术的治疗效果观察

      作者：梁永明，覃秋健，蒙顺龙，黄尚辉，韦承德，韦逸琛    来宾市人民医院普通外科，广西 来宾 546100

      卷次： 2019年30卷12期

      【摘要】 目的 研究腹腔镜胃癌D2顺向式淋巴结清扫手术的治疗效果。方法 选取来宾市人民医院普通外科于2017年12月至2018年12月收治的64例胃癌患者进行研究，按照随机数表法将患者分为观察组和对照组，每组32例。对照组行开腹D2根治术，观察组则行腹腔镜D2顺向式淋巴结清扫术。比较两组患者的围手术期观察指标、淋巴结清扫以及并发症发生情况。结果 治疗后，观察组和对照组患者术中出血量[(178.53±19.45) mL vs(228.68±25.69) mL]、切口长度[(6.42±2.13) cm vs (12.46±5.63) cm]、术后止痛剂使用次数[(0.73±0.11)次 vs (1.31±0.26)次]比较，观察组均明显优于对照组，且手术时间[(233.32±28.56) min vs (259.57±41.63) min ]、胃肠功能恢复时间[(2.14±0.61) d vs (2.84±1.42) d]、胃管拔除时间[(6.31±1.52) d vs (7.28±1.45) d]、肠鸣音恢复时间[(2.23±1.05) d vs(4.49±1.18) d]、排气时间[(2.73±0.32) d vs (3.47±0.41) d]、下床活动时间[(3.03±1.25) d vs (4.27±1.31) d]以及住院时间[(7.56±3.34) d vs (12.47±5.66) d]比较，观察组均明显短于对照组，差异均有统计学意义(P<0.05)；观察组患者脾门区域淋巴结清扫数量为(3.92±0.43)枚，明显多于对照组的(3.71±0.32)枚，差异有统计学意义(P<0.05)；观察组患者的并发症发生率为25.0%，明显低于对照组的50.0%，差异有统计学意义(P<0.05)。结论 腹腔镜胃癌D2顺向式淋巴结清扫手术与传统开腹手术临床疗效相当，但其手术创伤更小、并发症更少，患者术后恢复较快，且对脾门区域淋巴结清扫率较高，值得在临床推广应用。
      【关键词】 腹腔镜手术；胃肿瘤；D2淋巴结清扫术；顺向式
      【中图分类号】 R735.2 【文献标识码】 A 【文章编号】 1003—6350（2019）12—1535—04

Efficacy of laparoscopic D2 lymphadenectomy for gastric cancer.
LIANG Yong-ming, QIN Qiu-jian, MENGShun-long, HUANG Shang-hui, WEI Cheng-de, WEI Yi-chen. Department of General Surgery, Laibin People's Hospital,Laibin 546100, Guangxi, CHINA
【Abstract】 Objective To study the efficacy of laparoscopic D2 lymphadenectomy for gastric cancer.Methods Sixty-four patients with gastric cancer admitted to Department of General Surgery, Laibin People's Hos-pital from December 2017 to December 2018 were randomly divided into study group and control group according tothe random number table method, with 32 cases in each group. The control group was treated with open D2 radical opera-tion, while the study group was treated with laparoscopic D2 lymphadenectomy. The perioperative observation indexes,lymph node dissection, and complications were observed and compared between the two groups. Results After treat-ment, the intraoperative blood loss, the incision length, the number of postoperative analgesics used in the observationgroup were significantly better as compared with those in the control group: (178.53±19.45) mL vs (228.68±25.69) mL,(6.42±2.13) cm vs (12.46±5.63) cm, (0.73±0.11) times vs (1.31±0.26) times; the operation time, gastrointestinal functionrecovery time, gastric tube removal time, bowel sound recovery time, exhaust time, time to get out of bed, and the hospi-talization time were significantly shorter: (233.32±28.56) min vs (259.57±41.63) min, (2.14±0.61) d vs (2.84±1.42) d,(6.31±1.52) d vs (7.28±1.45) d, (2.23±1.05) d vs (4.49±1.18) d, (2.73±0.32) d vs (3.47±0.41) d, (3.03±1.25) d vs (4.27±1.31) d, (7.56±3.34) d vs (12.47±5.66) d; the differences were all statistically significant (P<0.05). The number of lymphnode dissection in the spleen area of the observation group was 3.92±0.43, which was significantly higher than 3.71±0.32 of the control group (P<0.05). The complication rate of the observation group was 25.0%, significantly lower than50.0% of the control group (P<0.05). Conclusion Laparoscopic D2 lymphadenectomy for gastric cancer has the sameclinical effect as traditional laparotomy, but it has less trauma, fewer complications, faster recovery after operation, andhigher lymph node dissection rate in splenic hilum region, which is worthy of clinical application.
      【Key words】 Laparoscopic surgery; Gastric cancer; D2 lymphadenectomy; Clockwise