LigaSure在腹腔镜胃癌根治术中的应用

目的探讨LigaSure在腹腔镜胃癌根治术中的应用价值。方法2001年7月～2007年7月，应用LigaSure行腹腔镜胃癌根治性切除术71例，按TNM分期，Ⅰ期15例，Ⅱ期33例，Ⅲa期23例。行根治性全胃切除术27例，根治性远侧胃大部切除术39例，根治性近侧胃大部切除术5例。采用腹腔镜辅助手术方法：以脐孔，左、右锁骨中线肋缘下，脐与剑突连线上、中1／3交界点为手术操作孔，术中扩大剑突下操作孔3～5cm为辅助切口。术中均采用LigaSure分离、处理血管，直接凝固切断包含直径达7mm血管的网膜及胃周血管；胃癌淋巴结清扫时，联合应用超声刀裸化血管，再用LigaSure钳夹凝固后，于闭合带远端剪断血管，完成腹腔镜下D2胃癌根治手术。结果71例均手术成功，无中转开腹，术中出血少，无术中、术后严重并发症发生，术后近期肺部感染3例、应激性溃疡出血1例、十二指肠残端漏1例（保守治愈）。LigaSure闭合胃周血管良好，未使用钛夹或腔镜专用切割吻合器（Endo—GIA）。71例随访4～72个月，平均38．6月，死亡11例（其中9例因肿瘤转移），远处转移10例，复发14例，2例术后远期吻合口狭窄。结论LigaSure行腹腔镜胃癌根治术安全、可靠，是腹腔镜手术理想的切割止血工具。

LigaSure Vessel Sealing System in Laparoscopic Radical Gastrectomy for Gastric Cancer

Objective To explore the value of the LigaSure vessel sealing system in laparoscopie radical gastrectomy for patients with gastric cancer. Methods From July 2001 to July 2007, 71 cases of gastric cancer, including 15 cases of TNM stage Ⅰ , 33 cases of stage Ⅱ , and 23 cases of stage Ⅲ a, were treated in our hospital with laparoseopie radical gastreetomy by using the LigaSure. Among the cases, radical gastrectomy was performed on 27 patients, radical distal gastrectomy was carried out in 39, and radical proximal gastreetomy was made in 5. Laparoseopy was employed during the operations. Four trocars were inserted through the umbilicus, below the costal arch at both the mid-clavicular lines, or at the junction of the upper one third and lower two third of the line between the umbilicus and the xiphoid process. All the vessels, including perigastrie and omental vessels with a diameter up to 7 ram, were separated, cut and coagulated by using the LigaSure. D2 lymph node dissection was also performed with the system combined with harmonic scalpel. Results The procedures was completed in all of the 71 patients without conversion to open surgery. None of the cases had massive hemorrhage or serious intra- and post-operative complications. After the operation, 3 patients developed pulmonary infection, 1 showed stress ulcer bleeding, and one had duodenal stub leaking （cured by conservative therapy）. None of the cases need titanium clips or Endo-GIA to close the vessels. The patients were followed up for 4 to 72 months with a mean of 38.6, 11 of them died during the period （9 of which died of tumor metastasis） , 10 showed distant metastasis, 4 had recurrence of the gastric cancer, and 2 developed long-term auastomotic stenosis. Conclusion As an optimal hemostatic tool, the LigaSure Vessel Sealing System is safe and feasible for laparoscopic radical gastrectomy.