腹腔镜辅助下根治性胃切除术17例临床初步报告

Laparoscope-assisted radical gastrectomy

目的 探讨腹腔镜辅助下根治性胃切除术的可行性、方法和效果。方法 17例胃癌病人行腹腔镜辅助下根治性胃切除术 ,其中根治性全胃切除术 3例 ,近端胃大部切除术 4例 ,远端胃大部切除术 10例。结果 17例中 ,除 2例中转开腹外 ,其余 15例均成功进行腹腔镜手术。手术平均用时 :全胃切除 40 1min( 3 40～ 475min) ,近端胃切除 2 5 4 3min( 2 12～ 3 40min) ,远端胃切除 3 2 4 5min( 2 70～ 3 77min)。术中平均出血量 :全胃切除 65 0ml( 4 0 0～ 90 0ml) ,近端胃切除 12 5ml( 5 0～ 2 0 0ml) ,远端胃切除 12 5ml( 10 0～ 2 0 0ml) ,平均清扫淋巴结 15 17枚 ( 8～ 41枚 )。术后病人平均胃肠功能恢复时间 3 4d( 2～ 5d) ,下床活动时间 3 5d( 2～ 5d) ,进流质时间 4 5d( 3～ 6d) ,术后近期效果良好。无 1例手术并发症。结论 腹腔镜胃癌根治术安全、可行 ,能够达到与开腹手术相当的根治效果 ,且具有创伤小、术后恢复快等优点。

Objective To explore the feasibility, method, and clinical outcomes of laparoscope-assisted radical gastrectomy. Methods Laparoscope-assisted gastrectomy was performed in 17 cases of gastric cancer, including radical total gastrectomy in 3 cases, proximal gastrectomy in 4 cases, and distal gastrectomy in 10 cases. Results Laparoscope-assisted surgery was successfully performed in 15 cases. There was only 2 cases converted to abdominal opening. The average operative time for total gastrectomy, proximal gastrectomy, and distal gastrectomy was 401 min (340-475 min), 254.3 min (212-340 min), and 324.5 min (270-377 min), respectively. The average blood loss in total gastrectomy, proximal gastrectomy, and distal gastrectomy was 650 ml (400-900 ml), 125 ml (50- 200 ml) , and 125 ml (100-200 ml), respectively. The average number of dissected lymph nodes was 15.17 (8-41). The average time for gastrointestinal function recovery, for the patients to stand up, and for the start of oral liquids was 3.4 d (2nd-5th day), 3.5 d (2nd-5th day), and 4.5 d (3rd-6th day) after operation, respectively. The postoperative outcomes were satisfactory. No complications were found. Conclusion Laparoscope-assisted radical gastrectomy is safe, feasible, and minimally invasive and can achieve the same result of abdominal opening.