腹腔镜辅助胃癌D2根治术联合胃背侧系膜近胃端完整系膜切除术对进展期胃癌患者肠黏膜屏障功能和腹腔微转移的影响

摘要 目的：探讨腹腔镜辅助胃癌D2根治术联合胃背侧系膜近胃端完整系膜切除术对进展期胃癌（AGC）患者肠黏膜屏障功能和腹腔微转移的影响。方法：选取2016年12月～2018年12月我院收治的105例AGC患者，按随机数字表法分为对照组（n=52）和实验组（n=53），分别施行腹腔镜辅助胃癌D2根治术、腹腔镜辅助胃癌D2根治术联合胃背侧系膜近胃端完整系膜切除术。观察两组手术情况（淋巴结清扫数量、手术时间、术中出血量、近切缘距离）、胃肠功能恢复指标（肛门排气时间、经口进食时间、肠鸣音恢复时间）、并发症、住院时间及术前、术后1 d、3 d、7 d肠黏膜屏障功能尿乳果糖/甘露醇（L/M）、血清二胺氧化酶（DAO）]、气腹后、关腹前腹腔微转移指标多巴胺脱羧酶（DDC）、癌胚抗原（CEA）]，并于术后12个月随访两组复发率。结果：实验组术中出血量少于对照组（P＜0.05）；两组经口进食时间、肛门排气时间、住院时间、肠鸣音恢复时间比较无差异（P＞0.05）；术前、术后1 d、3 d、7 d两组血清DAO水平、尿L/M比较无差异（P＞0.05）；关腹前实验组腹腔冲洗液DDC、CEA水平低于对照组（P＜0.05）；两组并发症总发生率比较，差异无统计学意义（P＞0.05）；术后12个月随访，实验组和对照组各失访2例，实验组复发率3.92%（2/51）低于对照组20.00%（10/50）（P＜0.05）。结论：腹腔镜辅助胃癌D2根治术联合胃背侧系膜近胃端完整系膜切除术治疗AGC，能有效降低术中出血量，恢复胃肠功能，减少腹腔微转移及术后复发，且未增加肠黏膜屏障功能损伤，安全性高。

Effect of Laparoscopic Assisted D2 Radical Gastrectomy Combined with Complete Proximal Gastrectomy of Gastric Dorsal Mesentery on Intestinal Mucosal Barrier Function and Peritoneal Micrometastasis in Patients with Advanced Gastric Cancer

ABSTRACT Objective: To investigate the effect of laparoscopic assisted D2 radical gastrectomy combined with complete proximal gastrectomy of gastric dorsal mesentery on intestinal mucosal barrier function and peritoneal micrometastasis in patients with advanced gastric cancer (AGC). Methods: From December 2016 to December 2018, 105 patients with AGC in our hospital were selected. The patients were randomly divided into control group (n=52) and experimental group (n=53) by random number table method. Laparoscopic assisted D2 radical gastrectomy, laparoscopic assisted D2 radical gastrectomy combined with complete proximal gastrectomy of gastric dorsal mesentery were performed respectively. The operation conditions (number of lymph node dissection, operation time, intraoperative blood loss, distance to the resection margin), gastrointestinal function recovery index (anal exhaust time, oral feeding time, bowel sounds recovery time), complications, hospitalization time and before operation, 1 d, 3 d, 7 d after operation intestinal mucosal barrier function urine lactulose / mannitol (L/M), serum diamine oxidase (DAO)], after pneumoperitoneum and before abdominal closure peritoneal micrometastasis indexes dopamine decarboxylase (DDC), carcinoembryonic antigen (CEA)] were observed. The recurrence rates of the two groups were followed up 12 months after operation. Results: The intraoperative blood loss in experimental group was less than that in control group (P<0.05). There were no significant differences in the oral feeding time, anal exhaust time, bowel sounds recovery time and hospitalization time between the two groups (P>0.05). Before operation, 1 d, 3 d, 7 d after operation, there were no significant differences in serum DAO levels and urine L/M between two groups (P>0.05). The DDC and CEA levels in peritoneal lavage fluid in the experimental group were lower than those in the control group before abdominal closure (P<0.05). There were no significant differences in the total incidence of complications between the two groups (P>0.05). 12 months after follow-up, 2 cases were lost in the experimental group and the control group. The recurrence rate of the experimental group was 3.92% (2/51) lower than that of the control group 20.00% (10/50) (P<0.05). Conclusion: Laparoscopic assisted D2 radical gastrectomy combined with complete proximal gastrectomy of gastric dorsal mesentery in the treatment of AGC can effectively reduce intraoperative blood loss, restore gastrointestinal function, reduce abdominal micrometastasis and postoperative recurrence, and does not increase intestinal mucosal barrier function damage, with high safety.