切换至 "中华医学电子期刊资源库"

中华普外科手术学杂志(电子版) ›› 2024, Vol. 18 ›› Issue (04) : 393 -396. doi: 10.3877/cma.j.issn.1672-6448.2024.04.012

论著

腹腔镜近端胃癌根治术中拓展胃后间隙在肥胖患者中的应用研究
吉顺富1,(), 汤晓燕1, 徐进1   
  1. 1. 226600 江苏海安,海安市中医院普外科
  • 收稿日期:2024-02-01 出版日期:2024-08-26
  • 通信作者: 吉顺富

Application of expanding retrogastric space in obese patients during laparoscopic radical resection of proximal gastric cancer

Shunfu Ji1,(), Xiaoyan Tang1, Jin Xu1   

  1. 1. Department of General Surgery, Hai’an Hospital of Traditional Chinese Medicine, Haian Jiangsu Province 226600, China
  • Received:2024-02-01 Published:2024-08-26
  • Corresponding author: Shunfu Ji
  • Supported by:
    Science and Technology Plan Project of Nantong City, Jiangsu Province(JCZ20110)
引用本文:

吉顺富, 汤晓燕, 徐进. 腹腔镜近端胃癌根治术中拓展胃后间隙在肥胖患者中的应用研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(04): 393-396.

Shunfu Ji, Xiaoyan Tang, Jin Xu. Application of expanding retrogastric space in obese patients during laparoscopic radical resection of proximal gastric cancer[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(04): 393-396.

目的

探讨拓展胃后间隙在肥胖患者腹腔镜近端胃癌根治术(LPG)中的应用价值和可行性。

方法

基于前瞻性对照研究,纳入2021年1月至2023年12月行近端胃癌根治术的60例肥胖患者。按照数字表法随机分为两组,每组患者各30例。观察组患者行拓展胃后间隙的腹腔镜近端胃癌根治术;对照组行常规腹腔镜近端胃癌根治术。采用统计学软件SPSS 22.0分析数据。围手术期指标和炎症指标等计量资料用()表示,行独立样本t检验;术后并发症等计数资料用[例(%)]表示,比较采用χ2检验。P<0.05表示差异有统计学意义。

结果

两组患者均完成腹腔镜近端胃癌根治术,无中转开腹。观察组患者手术时间及出血量较对照组明显减少,差异有统计学意义(P<0.05);术后3 d观察组患者C反应蛋白(CRP)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)和白细胞(WBC)水平显著低于对照组,差异有统计学意义(P<0.05);观察组患者并发症总发生率虽低于对照组,但差异无统计学意义(P>0.05)。

结论

拓展胃后间隙在肥胖患者腹腔镜近端胃癌根治术中可缩短手术时间,减少术中出血量,降低炎症水平,此方法在肥胖胃癌患者中安全可行。

Objective

To explore the application value and feasibility of expanding retrogastric space in obese patients undergoing laparoscopic radical gastrectomy (LPG) for proximal gastric cancer.

Methods

Based on a prospective controlled study, 60 obese patients who underwent radical resection for proximal gastric cancer between January 2021 and December 2023 were included. They were divided into two groups according to numerical random table method, with 30 patients in each group. Observation group underwent laparoscopic radical gastrectomy to expand the retrogastric space. The control group underwent conventional laparoscopic radical gastrectomy of proximal gastric cancer. Statistical software SPSS 22.0 was used to analyze the data. Perioperative indexes and inflammatory indexes were represented by (), and independent sample t test was performed. The statistical data of postoperative complications were represented by [cases (%)], and χ2 test was used for comparison. P<0.05 indicated that the difference was statistically significant.

Results

All patients in both groups underwent laparoscopic radical gastrectomy without conversion to laparotomy. Operation time and blood loss in observation group were significantly reduced compared with control group, the difference was statistically significant (P<0.05). The levels of C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and white blood cell (WBC) in 3 d observation group were significantly lower than those in control group, with statistical significance (P<0.05). The total incidence of complications in observation group was lower than that in control group, but the difference was not statistically significant (P>0.05).

Conclusion

Expanding the retrogastric space can shorten the operation time, reduce intraoperative blood loss and reduce the level of inflammation in obese patients with proximal gastric cancer during laparoscopic radical gastrectomy. This method is safe and feasible in obese patients with gastric cancer.

表1 两组患者一般资料比较
表2 两组患者围手术期指标比较(
表3 两组患者炎症指标比较(
表4 两组患者术后并发症比较 [例(%)]
[1]
刘宗超, 李哲轩, 张阳, 等. 2020全球癌症统计报告解读[J/CD]. 肿瘤综合治疗电子杂志, 2021, 7(02): 1-13, I0001.
[2]
Xia C, Dong X, Li H, et al. Cancer statistics in China and United States, 2022: profiles, trends, and determinants[J]. Chin Med J (Engl), 2022, 135(5): 584-590.
[3]
Shi Y, Ju M, Di X, et al. Prognostic value of modified-Gustave-Roussy Immunity Score in resectable proximal gastric cancer[J]. Medicine (Baltimore), 2023, 102(12): e33334.
[4]
汪欣, 陈晓. 近端胃癌的诊断与治疗进展[J]. 中华普通外科杂志, 2023, 38(04) : 241-244.
[5]
仇广林, 李啸文, 王海江, 等. 内脏型肥胖对胃癌根治术后早期并发症的影响[J]. 中华胃肠外科杂志, 2022, 25(07): 596-603.
[6]
Nudotor RD, Prokopowicz G, Abbey EJ, et al. Comparative Effectiveness of Roux-en Y Gastric Bypass Versus Vertical Sleeve Gastrectomy for Sustained Remission of Type 2 Diabetes Mellitus[J]. J Surg Res, 2021, 261: 407-416.
[7]
Guan WL, He Y, Xu RH. Gastric cancer treatment: recent progress and future perspectives[J]. J Hematol Oncol, 2023, 16(1): 57.
[8]
Japanese Gastric Cancer Association. Japanese Gastric Cancer Treatment Guidelines 2021 (6th edition)[J]. Gastric Cancer, 2023, 26(1): 1-25.
[9]
Liu K, Xu P, Lv J, et al. Peritoneal high-fat environment promotes peritoneal metastasis of gastric cancer cells through activation of NSUN2-mediated ORAI2 m5C modification[J]. Oncogene, 2023, 42(24): 1980-1993.
[10]
李爱华, 龚云翔, 闫元, 等. 不同淋巴结示踪方案在腹腔镜保留脾脏的近端胃癌脾门淋巴结清扫中的临床研究[J/CD]. 中华普外科手术学杂志(电子版), 2022, 16(05): 537-540.
[11]
张斌, 陈进, 谢智惠. 改良食管胃吻合双肌瓣成形术与传统食管胃前壁吻合在腹腔镜近端胃癌根治术中的临床效果对比研究[J/CD]. 中华普外科手术学杂志(电子版), 2023, 17(02): 172-175.
[12]
王领, 于洁, 段红亮, 等. 近端胃癌根治术中脾脏切除与脾脏保留的短期和长期效果[J/CD]. 中华普外科手术学杂志(电子版), 2020, 14(06): 558-561.
[13]
Ji X, Jin C, Ji K, et al. Double Tract Reconstruction Reduces Reflux Esophagitis and Improves Quality of Life after Radical Proximal Gastrectomy for Patients with Upper Gastric or Esophagogastric Adenocarcinoma[J]. Cancer Res Treat, 2021, 53(3): 784-794.
[14]
Zheng HL, Shen LL, Xu BB, et al. Oncological outcomes of laparoscopic versus open radical total gastrectomy for upper-middle gastric cancer after neoadjuvant chemotherapy: a study of real-world data[J]. Surg Endosc, 2023, 37(8): 6288-6297.
[15]
Misawa K, Kurokawa Y, Mizusawa J, et al. Negative impact of intraoperative blood loss on long-term outcome after curative gastrectomy for advanced gastric cancer: exploratory analysis of the JCOG1001 phase III trial[J]. Gastric cancer, 2022, 25(2): 459-467.
[1] 李国新, 陈新华. 全腹腔镜下全胃切除术食管空肠吻合的临床研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 1-4.
[2] 李子禹, 卢信星, 李双喜, 陕飞. 食管胃结合部腺癌腹腔镜手术重建方式的选择[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 5-8.
[3] 李乐平, 张荣华, 商亮. 腹腔镜食管胃结合部腺癌根治淋巴结清扫策略[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 9-12.
[4] 陈方鹏, 杨大伟, 金从稳. 腹腔镜近端胃癌切除术联合改良食管胃吻合术重建His角对术后反流性食管炎的效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 15-18.
[5] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[6] 李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[7] 刘世君, 马杰, 师鲁静. 胃癌完整系膜切除术+标准D2根治术治疗进展期胃癌的近中期随访研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 27-30.
[8] 任佳, 马胜辉, 王馨, 石秀霞, 蔡淑云. 腹腔镜全胃切除、间置空肠代胃术的临床观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 31-34.
[9] 赵丽霞, 王春霞, 陈一锋, 胡东平, 张维胜, 王涛, 张洪来. 内脏型肥胖对腹腔镜直肠癌根治术后早期并发症的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 35-39.
[10] 李博, 贾蓬勃, 李栋, 李小庆. ERCP与LCBDE治疗胆总管结石继发急性重症胆管炎的效果[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 60-63.
[11] 韩戟, 杨力, 陈玉. 腹部形态CT参数与完全腹腔镜全胃切除术术中失血量的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 88-91.
[12] 王露, 周丽君. 全腹腔镜下远端胃大部切除不同吻合方式对胃癌患者胃功能恢复、并发症发生率的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 92-95.
[13] 王庆亮, 党兮, 师凯, 刘波. 腹腔镜联合胆道子镜经胆囊管胆总管探查取石术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 313-313.
[14] 杨建辉, 段文斌, 马忠志, 卿宇豪. 腹腔镜下脾部分切除术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 314-314.
[15] 叶劲松, 刘驳强, 柳胜君, 吴浩然. 腹腔镜肝Ⅶ+Ⅷ段背侧段切除[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 315-315.
阅读次数
全文


摘要