摘要目的 分析实施D1和D2式胃癌切除术后患者的早期并发症发生率和死亡率,进一步提高胃癌手术治疗的效果.方法 收集2006年1月至2007年12月连续收治的实施D1或D2式胃癌切除术患者的临床资料,分析肿瘤临床病理特征、淋巴结廓清程度和术后早期并发症以及死亡率之间的关系.结果 130例患者实施了胃癌切除术,D1式34例,D2式96例.D2式术后早期并发症发生率明显高于D1式(20.6%比39.6%,P<0.05).进一步分析单个并发症的发生情况,两种术式差异无统计学意义.D2式术后死亡率为4.2%(4/96),D1式为0(0/34),但差异无统计学意义(P>0.05).死亡患者4例,均为D2式切除术.与吻合口瘘、胰瘘等相关的肺部并发症是术后患者死亡的重要原因.结论 D2式胃癌切除术是治疗胃癌安全有效的方法.淋巴结清除程度是增加术后并发症发生率和死亡率的因素.提高手术廓清技能和标准化胃癌淋巴结廓清术可能是减少术后早期并发症和死亡率的关键途径.

abstractsObjective To analyze the early mortality and morbidity of early postoperative complications of gastric cancer patients submitted to D1 or D2 gastrectomy for improving the surgical effect.Methods All consecutive patients who underwent D1 or D2 radical gastric resection between January 2006 and December 2007 were evaluated.Clinicopathologic features of the tumor,the extent of lymphadenectomy,the postoperative mortality and the early morbidity of complication were analysed.Results There were 130 patients admitted for the treatment of gastric cancer.34 underwent D1 dissection and 96 underwent D2 dissection.The early morbidity of D2 dissection was higher than that of D1 dissection (20.6% vs.39.6%,P<0.05).When complications were analyzed individually,there was no significant difference.Although the postoperative mortality was higher in the D2 group,no significant difference was observed(4.2% vs.0,P>0.05).4 patients underwent D2 dissection died.Considering the causes of the 4 died patients,respiratory complication related to anaatomotic and pancreatic leakage was the most important.Conclusion This study indicates that D2 dissection is a safe and effective procedure and the extent of lymphadenectomy may be related with high postoperative complication morbidity and mortality.Improving the surgical dissection skill and standardizing the gastric lymphadenectomy are the key ways to decrease the morbidity and mortality.