无瘤技术在腹腔镜辅助胃癌根治术中的应用

Application of tumor-free techniques in laparoscopy-assisted radical resection for gastric cancer

目的探讨无瘤技术在腹腔镜辅助胃癌根治术中的应用,总结经验体会。方法回顾性分析2009年9月1日至2010年9月30日在我科接受腹腔镜辅助胃癌根治术的39例患者的临床资料,包括手术时间、术中出血、围手术期并发症及随访结果,总结无瘤技术在腹腔镜辅助胃癌根治术中应用的经验。结果 39例患者均在腔镜下成功完成胃癌根治术,无中转开腹和二次手术。平均手术时间(232.5±53.2)min,术中平均出血量(110.6±67.4)ml。清扫淋巴结数目16～41枚,平均(23.6±6.2)枚。所有大体标本术后病理均显示上、下切缘阴性,肿瘤浸润深度T1～T3,术后TNM分期Ⅰ期6例,Ⅱ期19例,Ⅲ期14例。39例患者术后随访12～22个月,无局部复发,无腹腔及远处转移,未发生切口和穿刺口肿瘤种植。结论不接触原则、整块切除、切口保护、安全切缘、血管处理、锐性分离、操作由远及近等无瘤技术可在腹腔镜辅助胃癌根治术中得到很好的应用。

Objective To investigate the application of tumor free techniques in laparoscopy-assisted radical resection for gastric cancer ,and generalize the knowledge. Methods 39 patients underwent laparoscopy-assisted radical gastrectomy with tumor-free techniques from September 2009 to Septemper 2010. The clinical data including operation time ,intraoperative blood loss ,perioperative complications and follow-up outcomes were retrospectively analyzed. Results Laparoscopy-assisted radical gastrectomy was performed successfully in all 39 patients without conversion to open laparotomy and reoperation. The mean operation time was (232.5±53.2)min,and mean intra-operative blood loss was (110.6 ±67.4)ml. Lymph nodes harvested ranged from 16 to 41 per case with a mean number of (23.6±6.2). Pathological results revealed negative proximal and distal resection margin , from T1 to T3 invasion depth in all cases. After follow-up from 12 to 22 months , no local recurrence , no intraperitoneal or distant metastases , and no incision or port-site seeding were found. Conclusion Tumor-free techniques such as no touch isolation technique , en bloc resection, incision protection, safe resection margin, vessels ligation, sharp dissection, and surgical procedure from far to near , can be applied well in laparoscopy-assisted radical gastrectomy for gastric cancer.