腹腔镜下胃癌根治性切除术31例报告

Laparoscopic Radical Gastrectomy: Report of 31 Cases

目的 探讨腹腔镜下胃癌根治性的可行性. 方法 2006年8月～2007年5月行腹腔镜下胃癌根治性除术31例,其中根治性远端胃癌根治术26例,根治性全胃切除术5例. 结果 中转开腹手术1例,完全腹腔镜胃癌根治术2例,腹腔镜辅助下胃癌根治术28例.D1+β淋巴结清扫2例,D2/D2+ 淋巴结清扫 29例,联合肝脏部分切除1例.中位手术时间5 h(4.5～7 h).术中出血量中位数为150 ml(100～600 ml).术中输血1例.术中脾损伤1例.清扫淋巴结数目的中位数为20枚(14～33枚).本组无术后死亡.术后胃肠功能恢复时间的中位数4 d (3～6 d).术后胃无力1例,经保守治疗后3周恢复;1例全胃切除,回肠储袋出血1例;环甲关节半脱位1例;无吻合瘘及肺部感染.31例随访2～8个月(中位时间5个月),无复发和转移. 结论 腹腔镜胃癌根治术可行.

Objective To study the feasibility of laparoscopic radical gastrectomy.Methods From August 2006 to May 2007,31 patients with gastric cancer received laparoscopic radical gastrectomy(radical distal gastrectomy in 26 cases and radical total gastrectomy in 5).Results Among the cases,1 was converted to an open surgery,2 were treated completely by laparoscopic radical gastrectomy;and in the other 28 cases,the radical gastrectomy was performed under the assistance of laparoscopy.Lymph node dissection of D1+β was performed on 2 patients and D2/D2+ was adopted in the other 29.One case was done in combination with partial liver dissection.The median operative time was 5 h(range 4.5-7 h).The median blood loss was 150 ml(range,100-600 ml).One patient received blood transfusion during the operation.Intraoperative spleen injury occurred in one case.The median number of harvested lymph nodes was 20(range,14-33).No patient died after the surgery.The median time for gastrointestinal function recovery was 4 d(range 3-6 d).One patient developed gastroparalysis after the operation and was cured by conservative therapy.One of the patients had bleeding of the jejunal pouch after total gastrectomy.And one showed subluxation of the articulatio cricothyroideus.No anastomotic leakage and lung infection occurred after the surgery.And no recurrence or metastasis was found during a 2-to 8-month follow-up(median,5).Conclusion Laparoscopic radical gastrectomy is feasible and safe.