Objective: To explore the safety and efficacy of mesogastrium excision above the pancreas by the right approach in radical distal gastrectomy for cancer. Methods: A total of 154 distal gastric cancer patients in the Department of Gastrointestinal Surgery of the first affiliated Hospital of Chongqing Medical University, from October 2013 to October 2014, were included in this random controlled study. These patients were divided into the study group (n=78), who received mesogastrium excision above the pancreas by the right approach, and the control group (n=76), who received mesogastrium excision above the pancreas when by the left approach. Results: No significant differences were observed between the two groups in terms of the number of lymph node, postoperative recover, complications and 3-year survival rate(P>0.05), while significant differences were observed between the two groups in terms of operation time and surgical bleeding(P<0.05). Conclusions: In radical distal gastrectomy for cancer, the safety and efficacy for mesogastrium excision above the pancreas were the same by the right approach, compared to by the left approach, however, the group by the right approach had the advantage on the operation time and surgical bleeding.
目的： 探索在腹腔镜远端胃癌根治术中经右侧入路完成胰腺上方胃系膜完整切除手术的安全性与短期疗效分析。 方法： 2013年10月至2014年10月重庆医科大学附属第一医院胃肠外科收治的远端胃癌患者共154例，年龄>18岁，数字随机分入试验组[78例，男40例，女38例，年龄(55±8.5)岁]和对照组[(76例，男38例，女38例；年龄(54±9.6)岁]。试验组及对照组所有患者由同一医疗组进行手术，在胃癌根治的基础上，试验组行经右侧的胰腺上方胃系膜的完整切除，对照组行经左侧的胰腺上方胃系膜的完整切除，比较两组之间手术过程、术后恢复、并发症发生及3年无瘤生存的差异。 结果： 试验组与对照组在清扫淋巴结数目[(25±3.6)与(24.6±3.9)个]、术后恢复、术后并发症及3年无瘤生存率等方面，差异均无统计学意义(均P>0.05)；而在手术时间[试验组(155.4±59.2) min，对照组(175.6±51.2) min]，术中出血量[实验组术中出血量(56.3±23.1) ml，对照组术中出血量(79.3±30.1) ml]，两组差异有统计学意义(P<0.05)。 结论： 在腹腔镜远端胃癌根治术基础上，施行经右侧胰腺上方胃系膜完整切除是安全的，且二者短期疗效相当，但经右侧入路在手术时间和出血量方面显示出优势。.
Keywords: Gastric neoplasms; Mesogastrium excision; The right approach.