腹腔镜胃癌手术的临床应用与体会

Clinical application and experience of laparoscopic operation of gastric cancer

目的探讨腹腔镜胃癌手术的方法、可行性及其特点.方法自1999年5月至2004年7月,对22例胃癌患者施行了腹腔镜手术,其中胃远端癌行毕Ⅱ式根治性胃大部切除术(D2)10例(2例同时切除胆囊),胃小弯低分化腺癌(革囊胃)伴不全梗阻行全胃切除1例,胃底贲门癌行腹腔镜近端根治性胃大部切除术3例;8例Ⅳ期胃恶性肿瘤并幽门梗阻因无法切除而行胃空肠吻合术.结果所有患者均在腹腔镜下成功完成手术,无中转手术者,手术时间82～282 min,平均131.5 min;术中出血55～282 ml,平均113.2 ml;患者术后均在48 h内恢复胃肠道功能,胃空肠吻合术的患者术后梗阻很快得到解除,无并发症的发生.术后住院时间5～21 d,平均8.5 d.22例患者术后1～39个月获随访,在行根治性手术的9例Ⅱ期胃癌患者中有2例分别在术后24,28个月出现肺转移,全胃切除的患者于术后18个月因广泛转移而死亡,而Ⅰ期胃癌者均存活3年以上.结论腹腔镜对胃癌手术有一定的应用价值,特别对Ⅰ期胃癌行根治术和Ⅳ期胃癌行胃空肠吻合术,具有创伤小且术后恢复快的特点,是一种较安全的手术;对Ⅱ期至Ⅲ期胃癌需进一步探索.

Objective To explore the methods, feasibility and characteristics of laparoseopic surgery for gastric cancer. Methods From May 1995 to July 2004,laparoscopic operations were performed in 22 eases of gastric cancer in this hospital. Ten patients received Billroth Ⅱ distal subtotal gastrectomy（D2） and 2 eases received laparoscopic eholeeystectomy, Ⅰ ease of low differentiated adenoeareinoma in lesser eurrature of stomach（ hypertrophic gastritis）with incomplete obstruction received laparoscopie total gastreetomy, 3 eases of oesophagogastrie cancer received laparoscopic proximal subtotal gastrectomy, 8 cases of unresectable stage Ⅳ gastric cancer with pylorus obstruction received laparoscopie gastrojejunostomy. Results All the cases underwent laparoscopy successfully with no conversion to laparotomy. The operative time was 82-282 min （ mean 131.5 min）. Blood loss during the operation was 55-282 ml （ mean 113.2 ml） , flatus was present within 48 hours in all patients with no complications. The postoperative hospital stay was 5-21d （ mean 8.5 d）. Twenty-two patients were followed up postopertively for 1-39 months. Two of nine patients with stage Ⅱ gastric cancer undergoing radical operation had lung metastases 24 months and 28 months after operation,respectively. The total gastreetomy case died of wide metastases 22 months after operation,while all the stage I gastric cancer cases lived longer than 3 years. Conclusions Laparoscopic surgery for gastric cancer is feasible and safe with reduced operative trauma and rapid recovery ,espically for stage Ⅰ and stage Ⅳ gastric cancer with gastrojejunostomy,and the stage Ⅱ to stage Ⅲ gastric cancers need to be explored further.