腹腔镜下残胃癌根治切除3例报告

Laparoscopic Radical Gastrectomy for Gastric Stump Cancer: Report of 3 Cases

目的 探讨腹腔镜残胃癌切除的可行性. 方法 全身麻醉,平卧两腿分开位,术者站患者左侧,五孔法操作.入腹后先分离胃肠道与腹壁的粘连.淋巴结清扫次序:No4、11、10、2、7、8a、9、1、3、15、14v.取上腹部5～7 cm小切口,移出残胃及吻合口两端部分空肠,直视下Roux-en-Y方式重建消化道. 结果 3例残胃癌成功在腹腔镜下完成根治性切除,手术时间分别为300、280、350 min,术中出血量分别为100、200、40 ml,清扫淋巴结数量分别为12、15、20枚.术后胃肠功能恢复时间4.5、5、5 d,进食时间5 d,下床活动时间5.5 d.无手术并发症.3例分别随访10、9、2个月,无复发. 结论 残胃癌不是腹腔镜手术禁忌证,在掌握腹腔镜D2根治技术的基础上可尝试开展.

Objective To evaluate the feasibility of laparoscopic radical gastrectomy for gastric stump cancer.Methods The patients were placed in a supine position with legs apart,and the operator stood on their left side.Under general anesthesia,5 trocars were inserted,and the adhesions in the abdominal cavity were separated.Afterwards,the lymph nodes were dissected in an order of No.4,11,10,2,7,8a,9,1,3,15,and 14v.A 5-7 cm incision was made on the upper abdomen and the gastric stump and parts of the anastomosed jejuna were removed,and then the digestive tract was reconstructed by using Roux-en-Y under a direct vision.Results The gastric stump cancers were completely resected using laparoscopy in the 3 patients within 300,280,or 350 min.The blood loss was 100,200,and 40 ml respectively.And the number of lymph nodes dissected was 12,15,and 20.Their digestive tract functions recovered within 4.5,5,and 5 days postoperation,respectively.The patients were given oral liquids at day 5,and were permitted to get out of bed at day 5.5.The cases were followed up for 10,9,or 2 months,no postoperative complications or recurrence occurred during the period.Conclusions Gastric stump cancer is not a contraindication to laparoscopic gastrectomy.The surgeons who have mastered the laparoscopic D2 dissection are recommended to perform this procedure.