血管导向淋巴清扫术在腹腔镜胃癌根治术中的应用价值

Application value of vessel-guided lymph node dissection in laparoscopic radical gastrectomy for gastric cancer

摘要:

目的：探讨血管导向淋巴清扫术在腹腔镜胃癌根治术中的应用价值。
方法：回顾性分析84例接受腹腔镜胃癌根治术治疗的进展期胃癌患者临床资料，其中42例术中行血管导向淋巴清扫术（观察组），42例行常规系统淋巴结清扫术（对照组）。患者手术前后均行血清基质金属蛋白酶（MMPs）、血管内皮生长因子（VEGF）、人组织激肽释放酶7（KLK7）和E-钙黏蛋白（E-cad）检测，以及通过外周血与腹腔冲洗液癌胚抗原（CEA）与细胞角蛋白19（CK-19）的mRNA检测血液与腹腔微转移。
结果：两组术后淋巴结清扫数、切缘与肿瘤距离、肛门排气时间、住院时间和并发症率差异均无统计学意义（均P>0.05），但观察组手术时间和术中出血量明显优于对照组（均P<0.05）。两组术后血清MMP-2、MMP-9、VEGF和KLK7均明显降低，E-cad明显升高，但观察组术后MMP-9、VEGF和KLK7降低程度明显大于对照组（均P<0.05）。术前两组血液和腹腔微转移率差异无统计学意义（均P>0.05），但术后观察组血液和腹腔微转移率均明显低于对照组（均P<0.05）。观察组术后的总复发转移率均明显低于对照组，无进展生存期明显长于对照组（均P<0.05），两组总生存期及1、3年生存率比较差异无统计学意义 （均P>0.05）。
结论：腹腔镜胃癌根治术中采用血管导向淋巴清扫术能缩短手术时间和减少术中出血，并能通过减少微转移风险改善患者远期预后。

Abstract:

Objective: To investigate the application value of vessel-guided lymph node dissection in laparoscopic radical gastrectomy for gastric cancer.
Methods: The clinical data of 84 patients with advanced gastric cancer undergoing laparoscopic radical gastrectomy were retrospectively analyzed. Of the patients, 42 underwent vessel-guided lymph node dissection (observation group) and 42 cases underwent conventional systemic lymph node dissection (control group) during operation. The serum levels of matrix metalloproteinases (MMPs), vascular endothelial growth factor (VEGF), kallikreins 7 (KLK7), E-cadherin (E-cad) were determined, and the blood and peritoneal micrometastasis were also detected via examining the mRNA levels of carcinoembryonic antigen (CEA) and cytokeratin 19 (CK-19) in the peripheral blood and peritoneal washes.
Results: There were no significant differences in number of dissected lymph nodes, distance between incision margin and tumor, time to postoperative anus gas passage, length of hospital stay and incidence of complications between the two groups (all P>0.05). The operative time and intraoperative blood loss in observation group were significantly decreased compared with control group (both P<0.05). The serum levels of MMP-2, MMP-9, VEGF and KLK7 were significantly decreased and E-cad was significantly increased in both groups after operation, but the decreasing amplitudes of MMP-9, VEGF and KLK7 in observation group were significantly greater than those in control group (all P<0.05). The blood and peritoneal micrometastasis rates showed no significant differences between the two groups before operation (both P>0.05), but were significantly lower in observation group than those in control group after operation (both P<0.05). The overall incidence of postoperative recurrence/metastasis in observation group was significantly lower and the progression-free survival was significantly longer in observation than those in control group (both P<0.05), but there were no significant differences in the overall survival and 1- and 3-year survival rate between the two groups (all P>0.05).
Conclusion: Using vessel-guided lymph node dissection in laparoscopic radical gastrectomy for gastric cancer can shorten the operative time and reduce intraoperative bleeding, and also it may improve long-term prognosis of the patients by reducing the risk of micrometastasis.