全腹腔镜保留贲门胃底胃次全切除术治疗中上部胃癌的疗效及安全性

doi:10.19723/j.issn.1671-167X.2026.02.012

摘要/Abstract

摘要：

目的: 探讨全腹腔镜保留贲门和部分胃底的根治性胃次全切除术在中上部胃癌治疗中的疗效与安全性。方法: 采用回顾性队列研究方法分析2025年1月至6月复旦大学附属肿瘤医院收治的41例中上部胃癌患者的病例资料, 根据手术方式分为观察组(n=21)和对照组(n=20), 前者行全腹腔镜根治性胃次全切除术, 后者行腹腔镜全胃切除术。观察并分析患者的手术相关指标、术后恢复情况、并发症发生情况、病理诊断结果及营养状况等随访资料。结果: 两组患者均顺利完成手术, 无术中转为开放手术或更改术式情况。观察组手术总时间平均为(156.1±14.2) min, 显著短于对照组的(169.8±6.7) min(P < 0.05);两组消化道重建时间、术中出血量比较差异均无统计学意义(P>0.05);术后恢复方面, 观察组首次饮水时间平均为(2.1±0.4) d、首次进食流质时间平均为(3.4±0.5) d、术后住院时间平均为(6.3±0.5) d, 均显著短于对照组的(2.9±0.6) d、(3.9±0.5) d、(7.1±1.0) d(P均 < 0.05)。两组围手术期均无吻合口瘘、术后出血等并发症发生。病理诊断结果显示两组术后病理分期、淋巴结清扫数目差异无统计学意义(P>0.05);术后随访未见复发转移病例; 营养及生活质量方面, 观察组23.8%的患者体重指数较术前下降, 显著低于对照组的50.0%(P=0.046);观察组术后3个月血清维生素B12水平为(416.0±145.3) ng/L, 显著高于对照组的(315.0±128.2) ng/L(P=0.026)。结论: 全腹腔镜保留贲门和部分胃底的根治性胃次全切除术, 可保证中上部胃癌的肿瘤根治性, 且相较于腹腔镜全胃切除术, 具有手术时间更短、术后恢复更快、能更好维持患者术后营养状况及生活质量的优势, 安全可靠, 可为中上部胃癌的个体化治疗提供新选择。

关键词: 胃肿瘤, 胃次全切除术, Roux-en-Y, 治疗效果

Abstract:

Objective: To investigate the clinical efficacy and safety of totally laparoscopic radical subtotal gastrectomy with preservation of the cardia and partial gastric fundus in the treatment of middle-upper gastric cancer. Methods: A retrospective cohort study was conducted on 41 patients with middle and upper gastric cancer admitted to Fudan University Shanghai Cancer Center from January to June 2025. The patients were divided into an observation group (n=21) and a control group (n=20) according to the surgical method. The observation group underwent totally laparoscopic radical subtotal gastrectomy with cardia and partial fundus preservation, while the control group received laparoscopic total gastrectomy. Perioperative surgical indicators, postoperative recovery, complications, pathological results, and follow-up data on nutritional status were observed and compared between the two groups. Results: All patients in both groups successfully completed the surgery without conversion to open surgery or surgical modification during the operation. The average total operative time in the observation group was (156.1±14.2) min, which was significantly shorter than (169.8±6.7) min in the control group (P < 0.05). There were no significant differences in the time of digestive tract reconstruction and intraoperative blood loss between the two groups (P>0.05). The average time to first oral water intake, first liquid diet intake and postoperative hospital stay in the observation group were (2.1±0.4) d, (3.4±0.5) d and (6.3±0.5) d, respectively, all significantly shorter than those in the control group (2.9±0.6) d, (3.9±0.5) days and (7.1±1.0) d, all P < 0.05. No perioperative complications such as anastomotic leakage or postoperative bleeding occurred in either group. Pathological results showed no significant differences in postoperative pathological stage and number of dissected lymph nodes between the two groups (P>0.05). No tumor recurrence or metastasis was identified during the postoperative follow-up period.The proportion of patients with decreased body mass index (BMI) compared with preoperative level in the observation group was 23.8%, which was significantly lower than 50.0% in the control group (P=0.046). The serum vitamin B12 level in the observation group 3 months after surgery was (416.0±145.3) ng/L, significantly higher than (315.0±128.2) ng/L in the control group (P=0.026). Conclusion: Totally laparoscopic radical subtotal gastrectomy with cardia and partial fundus preservation can ensure the radicality of tumor resection for middle and upper gastric cancer. Compared with laparoscopic total gastrectomy, it has the advantages of shorter operative time, faster postoperative recovery, better maintenance of postoperative nutritional status and quality of life in patients, with reliable safety. It may serve as a novel individualized therapeutic option for patients with middle and upper gastric cancer.

Key words: Stomach neoplasms, Subtotal gastrectomy, Roux-en-Y, Treatment outcomes

中图分类号:

R735.2

刘友东, 吕亚军, 陈杰, 臧明德, 潘宏达, 刘晓文, 陆俊, 刘凤林. 全腹腔镜保留贲门胃底胃次全切除术治疗中上部胃癌的疗效及安全性[J]. 北京大学学报（医学版）, 2026, 58(2): 301-306.

Youdong LIU, Yajun LYU, Jie CHEN, Mingde ZANG, Hongda PAN, Xiaowen LIU, Jun LU, Fenglin LIU. Clinical efficacy and safety of totally laparoscopic subtotal gastrectomy with cardia-gastric fundus preservation in middle-upper gastric cancer[J]. Journal of Peking University (Health Sciences), 2026, 58(2): 301-306.

图/表 1

图1

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