目的

探讨基于膜解剖的完整系膜切除+D2根治术在进展期胃癌治疗中的应用效果。

方法

回顾性分析2020年6月至2023年2月175例进展期胃癌患者病例资料，依据术式不同分为对照组（单纯接受D2根治性手术，n=86例）和观察组（接受基于膜解剖的完整系膜切除+D2根治术，n=89例）。使用统计学软件SPSS 25.0处理数据，围手术期指标、胃肠功能指标等计量资料以（±s）表示，采用独立样本t检验；术后并发症等计数资料用［例（%）］表示，行χ²检验；采用Kaplan-Meier统计进展期胃癌复发风险函数。P＜0.05为差异有统计学意义。

结果

观察组患者术中出血量较对照组少，术中淋巴结清扫数量较对照组多，术后肠鸣音恢复时间较对照组短（P＜0.05）；术后7d，两组患者胃动素、胃泌素水平上升，且观察组高于对照组，二胺氧化酶（DAO）水平下降，且观察组较对照组低（P＜0.05）；两组患者术后并发症发生率差异无统计学意义（P＞0.05）；术后12个月，观察组患者复发率低于对照组（6.7% vs.16.3%，P=0.047）；观察组患者复发中位时间7.5（5.8，9.5）个月低于对照组6.5（5.0，9.3）个月（P=0.046）。

结论

将基于膜解剖的完整系膜切除+D2根治术应用于进展期胃癌患者中，术中出血量降低，淋巴结清扫数量提升，患者术后胃肠功能恢复快，且可降低胃癌复发风险，应用效果好。

Objective

To explore the application effect of complete mesocolic excision based on membrane anatomy+D2 radical resection in the treatment of advanced gastric cancer.

Methods

The case data of 175 patients with advanced gastric cancer from June 2020 to February 2023 were retrospectively analyzed.According to different surgical procedures，they were divided into the control group （receiving only D2 radical surgery，n=86 cases） and the observation group （receiving complete mesocolic excision based on membrane anatomy+D2 radical resection，n=89 cases）.The statistical software SPSS 25.0 was used for data processing.Perioperative indexes and gastrointestinal function were expressed as （±s），and independent sample t test was used between groups； Count data such as postoperative complications were expressed as［ cases（%）］，and χ² test was performed； The Kaplan-Meier method was used to statistically analyze the recurrence risk function of advanced gastric cancer.A P value＜0.05 was considered statistically significant.

Results

The intraoperative blood loss of patients in the observation group was less than that in the control group，the number of lymph node dissections during the operation was more than that in the control group，and the recovery time of bowel sounds after the operation was shorter than that in the control group （P＜0.05）.Seven days after the operation，the levels of motilin and gastrin in both groups increased，and those in the observation group were higher than those in the control group.The level of diamine oxidase （DAO） decreased，and that in the observation group was lower than that in the control group （P＜0.05）.There was no significant difference in the incidence of postoperative complications between the two groups （P＞0.05）.Twelve months after the operation，the recurrence rate of patients in the observation group was lower than that in the control group （6.7% vs.16.3%，P=0.047）.The median recurrence time of patients in the observation group was 7.5 （5.8，9.5） months，which was lower than 6.5 （5.0，9.3） months in the control group （P=0.046）.

Conclusion

Applying complete mesocolic excision based on membrane anatomy + D2 radical resection to patients with advanced gastric cancer can reduce intraoperative blood loss，increase the number of lymph node dissections，accelerate the recovery of gastrointestinal function after the operation，and reduce the recurrence risk of gastric cancer，with a good application effect.