腹腔镜辅助下进展期胃癌根治术的临床应用(附47例报告)

目的 研究腹腔镜在进展期胃癌中根治术能否满足胃癌手术切缘及D2淋巴结清扫的根治要求.方法 对47例行腹腔镜辅助下胃癌根治术的进展期胃癌患者的临床资料进行回顾性分析.结果 腹腔镜辅助下根治性近端胃大部切除术25例,根治性远端胃大部切除术11例,全胃根治术10例,1例中转开腹;手术时间(220±55)min,术中出血(150±87)ml.术后肛门排气时间、下床活动时间、术后住院时间分别为(5.1±0.5)d、(3.2±0.8)d、(9.0±1.5)d;腹腔镜辅助远端胃大部切除术11例,手术时间(284±37)min,术中出血(120±70)ml.术后肛门排气时间、下床活动时间、术后住院时间分别为(4.0±0.8)d、(3.2±1.5)d、(9.0±2.0)d.腹腔镜辅助全胃切除术10例,手术时间(330±50)min,术中出血(240±65)ml.术后肛门排气时间、下床活动时间、术后住院时间分别为(4.1±0.8)d、(3.2±0.8)d、(9.5±2.0)d.淋巴结清扫平均数(21.95±9.88)个,近端切缘与肿瘤距平均距离(6.41±2.13)cm;远端切缘与肿瘤平均距离(6.22±1.98)cm.无术中及术后并发症,近期疗效良好.结论 腹腔镜在进展期胃癌中根治术是安全可行的,能达到胃癌标准根治术(D2)的淋巴结清扫范围和肿瘤切缘,远期疗效有待进一步观察.

Clinical application of Laparoscope-assisted radical gastrectomy for advanced gastric cancer(47 case)

Objective To explore the feasibility,the safety,D2 lymph node dissection and clinical outcomes of laparoscope-assisted radical gastrectomy lot advanced gastric cancer.Methods The clinica data of 47 cases with advanced gastric treated with laparoscope-assisted radical gastrectomy were analyzed retrospectively.Results Laparoscope-assisted radical gastrectomy,proximal gastrectomy in 25 cases,distalgastrectomy in 11 cases,total gastrectomy in 10 cases;46 were performed Laparoscope-assisted surgery radical gastrectomy successfuly,and the other one was converted to abdominal opening.The average operative time for proximal gastrectomy,distal gastrectomy,and total gastrectomy was(220±55)min,(284±37)min,and (330±50)min,respectivel.The average blood loss in proximal gastrectomy,distal gastrectomy,and total gastrectomy was(150±87)ml,(120±70)ml,and(330±50)ml respectively.The average time of proximal gastrectomy for gastrointestinal function recovery,for the patients to stand up,and for the postoperative hospital stay was(5.1±0.5)d,(3.2±0.8)d and(9.0±1.5)d.The average time of distal gastrectomy for gastrointestinal function recovery,for the patients to stand up,and for the postoperative hospital stay was (4.0±0.8)d,(3.2±1.5)d and(9.0±2.0)d.The average time of total gastrectomy for gastrointestinal function recovery,for the patients to stand up,and for the postoperative hospital stay was(4.1±0.8)d,(3.2±0.8)d and(9.5±2.0)d.The mean total number of retrieved lymph nodes was(21.95±9.88),and the lengths of proximal and distal margins to the tumor were(6.41±2.13)cm and(6.22±1.98)cm respectively.No postoperative deaths or anastomtic fistulas were found.Its short-term outcomes were satisfactory.Conclusion Laparoscope-assisted radical gastrectomy with D2 lymphadenectomy is safe,feasible,which achieves adequate cancer clearance,but the long-term outcome is needed to be observed.