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目的探讨保留胰腺被膜的胃癌根治术治疗早期胃癌的临床疗效。方法前瞻性将笔者所在医院2011年1月到2011年12月期间收治的207例早期胃癌患者随机分为实验组95例和对照组112例,均行开腹胃癌根治术。其中实验组患者行常规胃癌根治术时不剥除胰腺被膜,对照组患者的手术按常规胃癌根治术进行。比较2组患者的临床疗效。结果实验组的术中出血量〔(134.1±5.3)m L比(150.3±3.7)m L〕和手术时间〔(76.4±5.7)min比(87.5±9.1)min〕均小于(或短于)对照组(P<0.05),但2组患者的总并发症发生率〔7.37%(7/95)比10.71%(12/112)〕、吻合口漏发生率〔3.16%(3/95)比4.46%(5/112)〕及吻合口狭窄发生率〔4.21%(4/95)比6.25%(7/112)〕比较差异均无统计学意义(P>0.05)。术后所有患者均获访,随访时间1~36个月,中位数为17.5个月。随访期间,实验组复发30例,转移23例,死亡44例;其1年和3年生存率分别为84.21%(80/95)和53.68%(51/95),1年和3年无瘤生存率分别为80.00%(76/95)和48.42%(46/95)。对照组复发37例,转移23例,死亡49例;其1年和3年生存率分别为85.71%(96/112)和56.25%(63/112),1年和3年无瘤生存率分别为81.25%(91/112)和49.11%(55/112)。2组患者的1年和3年生存率,以及1年和3年无瘤生存率比较差异均无统计学意义(P>0.05)。此外,2组患者的生存曲线和无瘤生存曲线比较差异也均无统计学意义(P>0.05)。结论对早期胃癌患者而言,保留胰腺被膜的胃癌根治术在术后生存率及无瘤生存率上与传统手术无明显差异,且有术中出血少、手术时间短等优点,值得进一步推广应用。
Objective To investigate the clinical efficacy of radical gastrectomy for preserving pancreatic capsule in the treatment of early gastric cancer. Methods Prospectively, 207 patients with early gastric cancer who were treated in our hospital from January 2011 to December 2011 were randomly divided into experimental group (95 cases) and control group (112 cases), all underwent open radical nephrectomy. The experimental group of patients with conventional gastric cancer radical surgery does not remove the pancreas, the control group of patients underwent conventional gastric cancer surgery. The clinical effects of two groups were compared. Results The intraoperative blood loss (134.1 ± 5.3) m L (150.3 ± 3.7) m L and the operative time (76.4 ± 5.7) min (87.5 ± 9.1) min in the experimental group were both less than (or shorter than) (7.37% (7/95) vs 10.71% (12/112)], and the incidence of anastomotic leakage [3.16% (3/95)) in the control group (P <0.05) 4.46% (5/112)], and the incidence of anastomotic stenosis (4.21% (4/95) vs 6.25% (7/112)]. There was no significant difference between the two groups (P> 0.05). All patients were followed up for 1 to 36 months with a median of 17.5 months. The follow-up period, the experimental group of 30 cases of recurrence, 23 cases of transfer, the death of 44 cases; 1-year and 3-year survival rates were 84.21% (80/95) and 53.68% (51/95), 1 year and 3 years Survival rates were 80.00% (76/95) and 48.42% (46/95), respectively. The control group had 37 cases of recurrence, 23 cases of metastasis and 49 cases of death. The 1-year and 3-year survival rates were 85.71% (96/112) and 56.25% (63/112), respectively. The 1-year and 3-year tumor- 81.25% (91/112) and 49.11% (55/112). The 1-year and 3-year survival rates and the 1-year and 3-year disease-free survival rates of the two groups showed no significant difference (P> 0.05). In addition, there was no significant difference between the two groups in survival curve and tumor-free survival curve (P> 0.05). Conclusion For patients with early stage gastric cancer, the radical operation of gastric cancer retaining the pancreas capsule has no significant difference in postoperative survival rate and tumor-free survival rate compared with the traditional operation, and has the advantages of less intraoperative bleeding and shorter operation time, which is worth further promotion and application .