辛乐 叶进军 阎玉矿 鲍兴

[摘要]目的 研究并探讨腹腔镜根治性全胃切除术治疗胃上部癌的近期效果及安全性。方法 选择2014年1月～2017年6月我院收治的60例胃上部癌患者，按照随机数字分组方法分为观察组和对照组，每组各30例。对照组患者实施传统开腹根治性全胃切除术，观察组患者实施腹腔镜根治性全胃切除术，比较两组患者淋巴结清扫数量、手术情况、术后疼痛评分、术后恢复时间、并发症发生率、免疫功能指标。结果 两组患者手术时间比较，差异无统计学意义（P>0.05），但观察组的淋巴结清扫数量多于对照组（P<0.05），术中出血量少于对照组（P<0.05）。术后8、12、24、48 h，观察组的疼痛评分均低于对照组（P<0.05）。在术后排气恢复时间、自主下床活动时间、进食流质食物时间、住院时间等，观察组均短于对照组（P<0.05）。观察组术后并发症总发生率为3.33%，对照组为20.00%，差異均有统计学意义（P<0.05）。对照组术后各项免疫功能指标均低于术前，差异有统计学意义（P<0.05），而观察组免疫功能指标在手术前后比较，差异无统计学意义（P>0.05）。结论 采用腹腔镜根治性全胃切除术治疗胃上部癌可减轻患者手术创伤、术后疼痛及免疫功能损害，减少术后并发症的发生，有利于促进术后恢复，还可有效清扫淋巴结，具有显著的近期效果。

[关键词]胃上部癌；腹腔镜；全胃切除术

[中图分类号] R735.2 [文献标识码] A [文章编号] 1674-4721（2018）4（b）-0057-04

Short-term effect and safety analysis of laparoscopic radical total gastrectomy in the treatment of upper gastric cancer

XIN Le YE Jin-jun YAN Yu-kuang BAO Xing

Department of General Surgery，Longgang Central Hospital of Shenzhen City，Guangdong Province，Shenzhen 518116，China

[Abstract]Objective To study and evaluate the short-term effect and safety of laparoscopic radical total gastrectomy in the treatment of upper gastric cancer.Methods 60 patients with upper gastric cancer were selected in our hospital from January 2014 to June 2017 were randomly divided into observation group and control group according to random number table method.30 cases in each group.In the control group，radical gastrectomy by traditional laparotomy was used，while in the observation group，laparoscopic total gastrectomy was performed.The number of lymph node dissection，operative conditions，postoperative pain score，postoperative recovery time，incidence of complications and immune function were compared between the two groups.Results There was no significant difference in operative time between the two groups（P>0.05）.However，the number of lymph node dissection in the observation group was more than that in the control group（P<0.05）.The intraoperative blood loss was less than that in the control group（P<0.05）.Pain scores in the observation group were lower than those in the control group at 8，12，24 and 48 h after operation（P<0.05）.The indexes of postoperative exhaust recovery time，time of being off bed independently，time to consume liquid food，and hospital stay，etc. in the observation group were shorter than those in the control group（P<0.05）.The total incidence of postoperative complications in the observation group was 3.33%，while that in the control group was 20.00% which differed significantly （P<0.05）.The indexes of immune function in the control group after operation were all lower than those before operation，the differences were statistically significant（P<0.05）.While those in the observation group were not statistically significant before and after operation（P>0.05）.Conclusion Laparoscopic radical total gastrectomy for the treatment of upper gastric cancer can alleviate the surgical trauma，postoperative pain and immune impairment，reduce postoperative complications，promote postoperative recovery，and effectively clear lymphatic nodes with a significant short-term effect.

[Key words]Upper gastric cancer；Laparoscopy；Total gastrectomy

胃上部癌属于常见的胃癌类型，主要是指发生于胃上部的恶性肿瘤，其致死风险较高[1]。临床上治疗胃上部癌多采取手术治疗，根治性全胃切除术是胃上部癌治疗的唯一根治方法，以往，临床上多采取开腹手术治疗，而近年来，随着腹腔镜手术的发展，腹腔镜根治性全胃切除术在胃上部癌中逐渐展开应用，其具有微创性的优点，但临床上关于该术式治疗胃上部癌的近期疗效尚存在争议[2-4]。本研究旨在探讨腹腔镜根治性全胃切除术治疗胃上部癌的近期效果及安全性，现报道如下。