目的

探讨腹腔镜胃癌D2根治合并腹主动脉旁淋巴结清扫（PAND）术治疗局部进展期胃癌的临床意义。

方法

回顾性分析2022年1月至2024年1月61例局部进展期胃癌患者资料，所有患者均行腹腔镜胃切除术，根据术中淋巴结清扫范围不同分为两组，对照组32例行D2淋巴结清扫术，观察组29例在此基础上行PAND。采用SPSS 26.0进行数据统计。围手术期指标等计量资料用（x±s）表示，行独立样本t检验；术后并发症等计数资料用［例（%）］描述，行χ²检验；利用Kaplan-Meier绘制生存曲线图，经Log-Rank检验分析两组生存情况。P＜0.05为差异有统计学意义。

结果

观察组患者手术时间、淋巴结清扫数目显著多于对照组（P＜0.05）；两组术中出血量、引流管拔除时间、术后住院天数比较，差异未见统计学意义（P＞0.05）；观察组患者并发症总发生率（15.6%）与对照组（10.0%）对比，差异无统计学意义（P＞0.05）；观察组患者累积总生存率为86.2%，虽高于对照组的75.0%，但差异未见统计学意义（P=0.317）。

结论

局部进展期胃癌患者行D2+PAND治疗虽延长了手术时间，但可清扫出更多数目淋巴结，且不增加手术并发症风险，安全可行。

Objective

To investigate the clinical significance of laparoscopic D2 radical resection combined with paraaortic lymph node dissection (PAND) in the treatment of locally advanced gastric cancer.

Methods

Data of 61 patients with locally advanced gastric cancer from January 2022 to January 2024 were retrospectively analyzed.All patients underwent laparoscopic gastrectomy and were divided into two groups according to the scope of intraoperative lymph node dissection.32 patients in the control group underwent D2 lymph node dissection, and 29 patients in the observation group received ascending PAND on this basis.SPSS 26.0 was used for data statistics.Measurement data such as perioperative indexes were expressed with (x±s),and independent sample t test was performed.Postoperative complications and other statistical data were described by［cases (%)］, and χ² tests were performed.Survival curves were drawn by Kaplan-Meier, and survival conditions of the two groups were analyzed by Log-Rank test.P＜0.05 was considered statistically significant.

Results

The operation time and the number of lymph node dissection in observation group were significantly higher than those in control group (P＜0.05).There was no significant difference in the amount of blood loss, the time of drainage tube removal and the number of days in hospital between the two groups (P＞0.05).There was no significant difference in the incidence of complications between the observation group (15.6%)and the control group (10.0%) (P＞0.05).The cumulative overall survival rate of observation group was 86.2%,which was higher than that of control group (75.0%), but the difference was not statistically significant (P=0.317).

Conclusion

In patients with locally advanced gastric cancer, D2+PAND treatment can prolong the operation time, but more lymph nodes can be removed without increasing the risk of surgical complications, which is safe and feasible.