目的

研究腹腔镜胃癌D2根治术+N0.16淋巴结清扫对局部进展期胃癌患者的应用效果。

方法

前瞻性选择2021年1月至2022年3月医院收治的局部进展期胃癌（LAGC）患者84例，采取随机数字表法将其分为观察组（n=42例）和对照组（n=42例），观察组实施腹腔镜胃癌D2根治术+N0.16淋巴结清扫术，对照组采用腹腔镜胃癌D2根治术。两组患者住院费用、术中出血量等计量资料以（±s）表示，行独立样本t检验；术后并发症总发生率等计数资料以百分数表示，用χ²检验；Clavien-Dindo并发症分级等级资料以频数表示，行秩和检验。绘制Kaplan-Meier生存曲线图，Log-Rank检验两组患者无病生存率及总生存率的差异。

结果

两组患者住院费用、住院时间、术后并发症总发生率、Clavien-Dindo并发症分级对比，差异无统计学意义（P＞0.05）；与对照组相比，观察组手术时间，术中出血量、淋巴结清扫总数及淋巴结清扫阳性数目更多（P＜0.05）；术后2年，观察组患者累积无病生存率高于对照组（92.9% vs. 76.2%，Log-Rank χ²=5.098，P＜0.05）。观察组患者累积总生存率与对照组对比，差异无统计学意义（95.2% vs.88.1%，Log-Rank χ²=1.653，P＞0.05）。

结论

发生No.16淋巴结局限性转移的LAGC患者行腹腔镜胃癌D2根治术+No.16淋巴结清扫，可有效提高术中淋巴结清扫数目，提高患者术后无病生存率，但会延长手术时间，增加术中出血。

Objective

To study the application effect of laparoscopic D2 radical gastrectomy combined with No.16 lymph node dissection in patients with locally advanced gastric cancer.

Methods

A total of 84 patients with locally advanced gastric cancer （LAGC） admitted to the hospital from January 2021 to March 2022 were prospectively selected.They were divided into the observation group （n=42 cases） and the control group （n=42 cases） by the random number table method.The observation group underwent laparoscopic D2 radical gastrectomy combined with No.16 lymph node dissection，and the control group underwent laparoscopic D2 radical gastrectomy.Measurement data such as hospitalization cost and intraoperative blood loss of the two groups of patients were expressed as （±s），and independent samples t test was performed； counting data such as the total incidence of postoperative complications were expressed as percentages，and chi-square test was used； the data of Clavien-Dindo complication grading were expressed as frequencies，and rank sum test was performed.The Kaplan-Meier survival curve was drawn，and the Log-Rank test was used to analyze the differences in disease-free survival rate and overall survival rate between the two groups of patients.

Results

There were no statistically significant differences in hospitalization cost，length of hospital stay，total incidence of postoperative complications，and Clavien-Dindo complication grading between the two groups of patients（P＞0.05）.Compared with the control group，the operation time of the observation group was longer，and the intraoperative blood loss，the total number of dissected lymph nodes and the number of positive dissected lymph nodes were more （P＜0.05）.Two years after surgery，the cumulative disease-free survival rate of the patients in the observation group was higher than that in the control group （92.9% vs. 76.2%，Log-Rank χ²=5.098，P＜0.05）.There was no statistically significant difference in the cumulative overall survival rate between the observation group and the control group （95.2% vs. 88.1%，Log-Rank χ²=1.653，P＞0.05）.

Conclusion

For LAGC patients with limited metastasis of No.16 lymph nodes，laparoscopic D2 radical gastrectomy combined with No.16 lymph node dissection can effectively increase the number of dissected lymph nodes during the operation and improve the disease-free survival rate of patients after surgery，but it will prolong the operation time and increase intraoperative bleeding.