CAJ | 학술논문

目的比较血管鞘内、外解剖法在进展期胃癌D2根治术中的疗效和安全性。方法回顾性分析2008年10月至2011年5月间在上海中医药大学附属曙光医院普外科接受治疗的101例进展期胃癌患者中，采用血管鞘内解剖法行胃癌D2根治性切除的88例患者（ VLND组）的临床资料，并选取2005年5月至2008年9月间接受同一手术组治疗的81例胃癌患者中，采用血管鞘外解剖法行胃癌D2根治术63例患者作为对照组，比较两组患者的治疗效果和安全性，并比较分析两组术后生存率差异。结果 VLND组根治性切除率达87.13％（88/101），对照组根治性切除率77.78％（63/81），VLND组根治性切除率较对照组明显提高（ P＜0.05）；VLND组平均每例清扫淋巴结量为25.2枚，明显高于对照组（19.32枚， P＜0.05）；VLND组和对照组分别有81例和68例得到平均3年的随访，肿瘤复发率分别为26.83％和48.72％，3年存活率分别为75.61％和56.41％，两组差异均有统计学意义（ P＜0.05）。两组间术中失血量、手术时间、术中和术后并发症发生率比较，差异均无统计学意义（ P＞0.05）。结论对Ⅱ期以上的进展期胃癌，血管鞘内解剖法符合现代肿瘤手术学的R0根治原则，循鞘内分离，切除血管周围融合淋巴结以及鞘内（上）可能残留的癌组织，可明显提高根治性切除率和术后生存率，是安全、可靠亦是可行的淋巴结清扫技术。
목적비교혈관초내、외해부법재진전기위암D2근치술중적료효화안전성。방법회고성분석2008년10월지2011년5월간재상해중의약대학부속서광의원보외과접수치료적101례진전기위암환자중，채용혈관초내해부법행위암D2근치성절제적88례환자（ VLND조）적림상자료，병선취2005년5월지2008년9월간접수동일수술조치료적81례위암환자중，채용혈관초외해부법행위암D2근치술63례환자작위대조조，비교량조환자적치료효과화안전성，병비교분석량조술후생존솔차이。결과 VLND조근치성절제솔체87.13％（88/101），대조조근치성절제솔77.78％（63/81），VLND조근치성절제솔교대조조명현제고（ P＜0.05）；VLND조평균매례청소림파결량위25.2매，명현고우대조조（19.32매， P＜0.05）；VLND조화대조조분별유81례화68례득도평균3년적수방，종류복발솔분별위26.83％화48.72％，3년존활솔분별위75.61％화56.41％，량조차이균유통계학의의（ P＜0.05）。량조간술중실혈량、수술시간、술중화술후병발증발생솔비교，차이균무통계학의의（ P＞0.05）。결론대Ⅱ기이상적진전기위암，혈관초내해부법부합현대종류수술학적R0근치원칙，순초내분리，절제혈관주위융합림파결이급초내（상）가능잔류적암조직，가명현제고근치성절제솔화술후생존솔，시안전、가고역시가행적림파결청소기술。
Objective To evaluate and compare the curative effect and safety of vagina vasorum lymph node dissection(VLND)and non-vagina vasorum lymph node dissection (NVLND)in patients with gastric cancer after D2 gastrectomy.Methods 101 cases of evaluable patients with gastric cancer , underwent radical gastrectomy from October 2008 to May 2011 were retrospectively analyzed .Of which,88 cases patients received VLND .And 81 cases operated from May 2005 to September 2008.Of which,63 cases patients received NVLND.The curative effect,safety and survival rate were recorded and compared between the two groups .Results In VLND group,88 cases received radical resection and the radical resection rate was 87.13%.In control group ,63 cases received redical resection and the radical resection rate was 77.78%.The radical resection rate in VLND group was much higher ( P<0.05 ) .The averge amount of lymph nodes in VLND group was 25.2,which was higher than the amount in control group (19.32, P<0.05 ) .With significant differences , the 3 year overall accumulative survival rates of VLND group and control group were 75.61% and 56.41%( all P <0.05 ) .The recurrence rate of VLND group and control group were 26.83%and 48.72%.No significant differences in blood loss ,operation time ,operative complication rate was found between the two groups ( all P>0.05 ) .Conclusions Vagina vasorum dissection satisfies the principal of modern oncology and operative surgery of R0 radical gastrectomy,which is recommended when clearing lymph node around arteries in radical gastrectomy for advanced gastric cancer in stage Ⅱabove .VLND is a safe technique with high radical resection rate and the post-operation survival rate .