手辅助腹腔镜胃癌根治手术技巧探讨

Feasibility and operative skills of hand-assisted laparoscopic radical surgery for gastric cancer : a report of 14 cases

目的探讨手辅助腹腔镜胃癌根治手术的可行性、手术技巧及短期治疗效果。方法对2009年11月至2011年6月我科施行的14例手辅助腹腔镜胃癌根治手术患者的临床资料进行回顾性分析,分析患者手术时间、术中出血量、术后肛门排气时间、住院时间、淋巴结清扫数目以及短期随访结果。结果全组14例患者手术均成功,无中转开腹。手术中位时间130min(90～180min);术中出血量50～150ml,平均(102.3±26.5)ml;术后排气时间2～4d,平均(3.2±1.3)d;术后开始进食时间(4.5±1.4)d;患者住院天数7～12d,平均住院天数(9.0±2.5)d;手术清扫淋巴结数目18～27枚,平均(22.2±5.3)枚。无围手术期并发症及死亡病例。随访2～20个月,1例ⅢC期患者死亡。结论手辅助腹腔镜胃癌根治手术具有与腹腔镜辅助胃癌根治手术同样的微创效果,但操作相对容易,更适合有丰富开腹手术经验,而腹腔镜技术薄弱的高年资医生。

Objective To investigate the feasibility and operative skills of hand-assisted laparoscopic radical surgery for gastric cancer. Methods From November 2009 to June 2011, fourteen cases of gastric cancer underwent hand-assisted laparoscopic radical resection in our department. Clinical data including operative time, intra-operative bleeding , hospital stay and short-term follow-up were analyzed. Results Hand-assisted laparoscopic radical resection was successfully performed in all 14 cases without conversion to open laparotomy. The median operation time was 130 min with a range from 90 to 180 min. The mean intra-operative blood loss was (102.3±26.5)ml. The mean anal exhaust time was (3.2±1.3)d, and mean time to oral feeding (4.5±1.4)d. The mean number of harvested lymph nodes was (22.2± 5.3). The mean hospital stay was (9.0±2.5)d. There were no peri-operative morbidity and mortality. Only one death occurred after a follow-up from 2 to 20 month. Conclusions Hand-assisted laparoscopic radical surgery for gastric caner has the same minimally invasive effect as laparoscopy-assisted radical gastrectomy, and is comparatively easier. It is more suitable for the senior doctors with rich experience of open surgery and poor experience of laparoscopic operations.