完全腹腔镜残胃癌根治术26例临床分析

目的探讨完全腹腔镜近端残胃癌根治术的安全性、可行性及近期疗效。方法回顾性分析福建省立医院2016年1月至2019年6月收治因胃良性病变曾行远端胃大部切除、BillrothⅡ式吻合术后的残胃癌病人,行腹腔镜近端残胃癌根治术,腔内Roux-en-Y吻合术重建消化道的26例病人临床资料。结果26例病人中肿瘤位于残胃底贲门9例,位于残胃空肠吻合口17例。病人均顺利完成腹腔镜残胃切除D2淋巴结清扫术及腔内Rouxen-Y食管空肠吻合重建消化道。手术时间(152.3±21.3)min,重建消化道时间(38.6±12.5)min,术中出血量(55.1±21.8)mL。平均清扫淋巴结(28.1±7.4)枚。上切缘距食道贲门连接线中位距离2.5(2.1,4.6)cm,距肿瘤上界中位距离5.5(4.1,6.2)cm,上切缘均未见阳性。辅助切口平均长度(4.1±0.8)cm。术后肛门排气时间(29.5±11.2)h,流质进食时间(19.1±8.6)h,术后住院时间(7.8±1.9)d。术后并发症:Clavien-Dindo分级Ⅰ级发生率为3.8%(1/26),辅助切口感染1例。Ⅱ级发生率为7.7%(2/26),其中炎性肠梗阻1例,腹腔感染1例,予保守治疗痊愈。无Ⅲ级以上并发症,无吻合口漏、出血、梗阻及手术相关死亡。26例病人均存活获得随访,平均随访时间9.2个月。食管空肠吻合口大小(4.6±0.5)cm,Roux-en-Y滞留综合征发生率为7.7%(2/26),反流性食管炎11.5%(3/26),无吻合口狭窄、未见肿瘤复发或转移者。结论应用完全腹腔镜技术行近端残胃癌术根治因胃良性病变行远端胃大部切除术后(BillrothⅡ式吻合)的病人安全可行,具有术中出血量少,术后恢复时间短等优点,并有满意的近期效果。

Total laparoscopic resection of gastric stump cancer:A clinical analysis of 26 cases

Total laparoscopic resection of gastric stump cancer：A clinical analysis of 26 cases YANG Chang-shun, YANG Feng-lan, CAI Shao-xin, et al. Department of Surgical Oncology, Fujian Provincial Clinic College, Fujian Medical University, Fuzhou 350001, China
Corresponding author: LI Wei-hua,E-mail:liwh68@sina.com
YANG Chang-shun and YANG Feng-lan are the first authors who contributed equally to the article
Abstract Objective To investigate the safety, feasibility and short-term outcome of total laparoscopic radical gastrectomy for proximal gastric stump cancer. Methods The clinical characteristics of 26 patients with proximal gastric stump cancer who received total laparoscopic radical gastrectomy from January 2016 to June 2019 in Fujian Provincial Hospital were analyzed retrospectively. Results The tumors located at the cardia of the fundus of the stomach (9 cases), and gastrojejunal anastomosis (17 cases) respectively. All the patients received D2 lymphadenectomy and Roux-en-Y esophagojejunostomy. The mean operation time was（152.3 ± 21.3）min, mean reconstruction time of digestive tract was（38.6 ± 12.5）min. The mean bleeding amount was（55.1 ± 21.8）mL. The average number of lymph node harvested was（28.1 ±7.4）. The upper margin was 2.5(2.1,4.6)cm away from the esophageal cardia junction and 5.5(4.1,6.2) cm away from the tumor. No positive margin was reported after pathological confirmation. The mean length of the auxiliary incision was (4.1±0.8) cm. The anal exhaust time and the first liquid food intake after surgery was (29.5 ± 11.2）h and（19.1 ± 8.6）h, respectively. The mean postoperative hospital stay was（7.8 ± 1.9）d. Three patients suffered from postoperative complications, including 1 (3.8%, 1/26) Grade Ⅰ complication (auxiliary incision infection), and 2 (7.7%, 2/26) Grade Ⅱ complications (1 case of inflammatory intestinal obstruction and 1 case of abdominal infection). All the patients with complication recovered after conservative treatment. No complication of Grade Ⅲor Ⅳ was observed in these patients. The mean follow-up was 9.2 months. The incidence of Roux-en-Y stasis syndrome was 7.7 % (2/26). The length of gastrojejunal anastomosis was（4.6±0.5）cm, and 11.5% (3/26) patients suffered from reflux esophagitis. There was no anastomotic stenosis, no tumor recurrence or metastasis. Conclusion Total laparoscopic surgery is safe and feasible in radical resection of proximal gastric stump cancer after Billroth Ⅱ anastomosis. It brings satisfactory result in bleeding control, postoperative surgery and short-term results.