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目的:比较D2+腹主动脉旁淋巴结清扫术(PAND)与D2根治术治疗进展期胃癌在疗效和安全性方面的差异。方法:纳入分析D2+PAND的胃癌根治术160例,为D2+PAND组,选择同期施行胃癌D2手术病人160例,作为对照组(D2组),比较两组并发症发生率和生存情况。结果:D2+PAND组和D2组平均手术时间分别为(329.9±102.4)min和(266.7±90.6)min,平均输血量分别为(564.7±752.5)m L和(459.3±473.4)m L,差异均有统计学意义(P<0.001)。两组并发症发生率比较差异无统计学意义。D2+PAND组和D2组平均生存期分别为(74.8±7.4)个月和(53.8±4.9)个月(P=0.105),中位生存期为36.4个月和23.4个月(P=0.123),无统计学差异。但是分层分析显示胃癌T4期病人D2+PAND组和D2组平均生存期分别为(28.1±4.6)个月和(17.2±2.8)个月,差异有统计学意义(P<0.05),对于合并第2站淋巴结转移的胃癌病人,平均生存期分别为(40.8±5.7)个月和(12.6±2.4)个月,差异有统计学意义(P<0.01)。结论:D2+PAND可改善T4期和存在第2站淋巴结转移进展期胃癌病人的预后。
Objective: To compare the efficacy and safety of D2 + para-aortic lymph node dissection (PAND) and D2 radical mastectomy in the treatment of advanced gastric cancer. Methods: One hundred and sixty patients undergoing D2 + PAND radical gastrectomy were enrolled in the D2 + PAND group. 160 patients undergoing D2 surgery for gastric cancer during the same period were selected as the control group (D2 group). The complication rates and survival were compared between the two groups. Results The mean operative time of D2 + PAND group and D2 group were (329.9 ± 102.4) min and (266.7 ± 90.6) min, respectively. The average blood transfusion volumes were (564.7 ± 752.5) m L and (459.3 ± 473.4) m L, respectively All were statistically significant (P <0.001). There was no significant difference in the incidence of complications between the two groups. The average survival time of D2 + PAND group and D2 group was (74.8 ± 7.4) months and (53.8 ± 4.9) months respectively (P = 0.105), and the median survival time was 36.4 months and 23.4 months (P = 0.123) , No statistical difference. However, the stratified analysis showed that the mean survival time of D2 + PAND group and D2 group was (28.1 ± 4.6) months and (17.2 ± 2.8) months respectively in T4 stage gastric cancer patients, the difference was statistically significant (P <0.05) The mean survival time of patients with gastric cancer with lymph node metastasis at the second station was (40.8 ± 5.7) months and (12.6 ± 2.4) months, respectively, with statistical significance (P <0.01). Conclusion: D2 + PAND can improve the prognosis of patients with stage T4 gastric cancer and advanced gastric cancer with stage 2 lymph node metastasis.