不同入路手术治疗远端胃癌患者的效果

摘要/Abstract

摘要： 目的回顾性分析右侧前入路、左侧后入路腹腔镜胃癌根治术（LG）治疗远端胃癌（GC）效果及对并发症的影响。方法收集商丘市立医院2021年1月~2023年12月治疗远端GC的80例患者临床资料,以手术方法不同将患者分为2组,其中行右侧前入路LG治疗的40例为研究组,行左侧后入路LG治疗的40例为对照组。对比2组围手术期指标、肿瘤标志物水平[糖类抗原125（CA125）、糖类抗原19-9（CA19-9）、癌胚抗原（CEA）]、胃肠道功能相关指标[二胺氧化酶（DAO）、胃蛋白酶原Ⅰ（PGⅠ）、D-乳酸]、胃肠道症状评定量表（GSRS）及并发症发生率。结果相较于对照组,研究组术中出血量、手术、肠鸣音恢复、排气及进食恢复时间较少,淋巴清扫数目增多（P<0.05）;术后3d、出院时、1个月研究组GSPS评分及术后3d CA125、CEA、CA19-9与对照组相比,明显降低（P<0.05）;术后3d研究组D-乳酸、DAO低于对照组,PGⅠ高于对照组（P<0.05）;术后2组并发症发生率相比,无明显差异（P>0.05）。结论远端GC行右侧前入路LG治疗可降低肿瘤负荷,改善患者胃肠功能障碍,创伤小,可提高淋巴结清扫率,促进术后康复。

关键词: 胃癌, 右侧前入路, 左侧后入路, 腹腔镜胃癌根治术, 并发症

Abstract: Objective To retrospectively analyze the effect of right anterior approach and left posterior approach laparoscopic radical gastric cancer (LG) for distal gastric cancer (GC) and the effect on complications. Methods Clinical data of 80 patients with distal gastric cancer (GC) treated at Shangqiu City Hospital from January 2021 to December 2023 were collected. Patients were divided into two groups based on different surgical approaches: the study group (40 patients) who underwent right anterior approach laparoscopic gastrectomy (LG) and the control group (40 patients) who underwent left posterior approach LG. The perioperative indicators, tumor marker levels [carbohydrate antigen 125 (CA125), carbohydrate antigen 19-9 (CA19-9), carcinoembryonic antigen (CEA)], gastrointestinal function-related indicators [diamine oxidase (DAO), pepsinogen I (PGI), D-lactate], gastrointestinal symptom rating scale (GSRS), and complication rate were compared between the two groups. Results Compared to the control group, the study group exhibited reduced intraoperative blood loss, shorter durations for surgery, bowel sound recovery, exhausting, and resuming food intake, as well as an increased number of lymph node dissections (P<0.05). At 3 days post-surgery, upon discharge, and at 1 month, the GSPS scores of the study group were significantly lower than those of the control group, as were the levels of CA125, CEA, and CA19-9 at 3 days post-surgery (P<0.05). At 3 days post-surgery, the study group had lower levels of D-lactate and DAO, and higher levels of PGⅠ compared to the control group (P<0.05). There was no significant difference in the incidence of complications between the two groups post-surgery (P>0.05). Conclusion Treatment with LG via the right anterior approach in distal GC can reduce tumor burden, improve gastrointestinal dysfunction in patients, cause minimal trauma, increase lymph node clearance rate, and facilitate postoperative recovery.

Key words: Gastric cancer, Right anterior approach, Left posterior approach, Laparoscopic radical gastrectomy, Complication

中图分类号:

R735.2

常伟, 凡梦琦, 张朋. 不同入路手术治疗远端胃癌患者的效果[J]. 承德医学院学报, 2025, 42(2): 114-117.

CHANG Wei, FAN Meng-qi, ZHANG Peng. The Effect of Different Surgical Approaches on Patients with Distal Gastric Cancer[J]. Journal of Chengde Medical University, 2025, 42(2): 114-117.

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链接本文: http://tougao.cdmc.edu.cn:8088/CN/

http://tougao.cdmc.edu.cn:8088/CN/Y2025/V42/I2/114

参考文献

[1] 朱虹玉,张云飞,骆惠玉,等. 胃癌病人周围神经病变症状体验及对日常活动的影响[J]. 护理研究,2020,34(11):1893-1897.
[2] 郭艳红,张雪丽,姚青林,等. 胃癌组织中幽门螺旋杆菌感染与原癌基因表达、病理特征的关系及其对术后癌复发的评估价值[J]. 热带医学杂志,2020,20(11):1479-1482.
[3] Ojima T, Nakamura M, Hayata K, et al.Short-term Outcomes of Robotic Gastrectomy vs Laparoscopic Gastrectomy for Patients With Gastric Cancer: A Randomized Clinical Trial[J]. JAMA Surg, 2021, 156(10): 954-963.
[4] 孙江华,李东辉,刘世浩,等. 全腔镜远端胃癌根治术与腹腔镜辅助远端胃癌根治术在消化道重建中的临床效果对比[J]. 临床和实验医学杂志,2022,21(5):497-501.
[5] 谢允虎,陈建峰,吴海明,等. 胃充盈超声检查联合血清学指标在胃癌术前TNM分期中的应用价值[J]. 临床超声医学杂志,2021,23(9):664-668.
[6] 严斌,朱俊江,吴佳健. 血清ProGRP、PG Ⅰ水平对胃息肉患者内镜下黏膜切除术后复发的影响[J]. 首都食品与医药,2022,29(7):19-22.
[7] 秦宇宁,赵天易,刘凤斌,等. 中文版胃肠道症状评定量表对胃肠道疾病患者测量学特性研究[J]. 中国全科医学,2023,26(18):2277-2285.
[8] Yang K, Lu L, Liu H, et al.A comprehensive update on early gastric cancer: defining terms, etiology, and alarming risk factors[J]. Expert Rev Gastroenterol Hepatol, 2021, 15(3): 255-273.
[9] 江永强,曹辉,姜宝,等. 腹腔镜辅助胃癌根治术应用于进展期胃癌的疗效分析[J]. 中国普外基础与临床杂志,2019,26(9):1087-1092.
[10] 梁小娥,邵燕,李娜,等. 腹腔镜远端胃癌根治术不同入路方式治疗胃癌的近期疗效对比观察[J]. 现代消化及介入诊疗,2018,23(5):665-667.
[11] 张杰,马贤纵,陈敬芳,等. 内镜下OTSC系统处理腹腔镜胃癌根治术后吻合口漏的临床疗效分析[J]. 胃肠病学和肝病学杂志,2023,32(5):488-492.
[12] 刘晓明,吕竟成,朱一辰. 后腹腔镜肾上腺肿瘤切除手术时间及术后并发症的影响因素分析及预测模型建立[J]. 国际外科学杂志,2023,50(10):670-675.
[13] 郭素英. 右侧前入路与左侧后入路腹腔镜远端胃癌根治术治疗胃癌患者的效果比较[J]. 中国民康医学,2022,34(7):140-142.
[14] 吴珊,王冰,方征,等. D-二聚体与癌胚抗原和糖链抗原19-9在胃癌患者肿瘤负荷及疗效评价中的预测价值[J]. 中国临床保健杂志,2020,23(2):220-222.
[15] 阎芳,李格林,李德亮,等. 腹腔镜辅助小切口胃癌根治术对进展期胃癌患者手术相关指标及术后胃肠功能恢复的影响[J]. 实用癌症杂志,2023,38(10):1702-1705.
[16] 唐潇然,呼健,赵鹏飞. 香砂六君子汤加减对胃癌患者术后肠黏膜屏障及免疫状态的影响[J]. 中国医药,2023,18(12):1874-1878.