腹腔镜辅助下远端胃癌根治术44例临床报告

Laparoscopy-assisted radical distal gastrectomy for gastric cancer: A clinical report of 44 cases

目的探讨腹腔镜辅助下远端胃癌根治及D2淋巴结清扫术的手术可行性及效果. 方法 2004年3月～2005年5月行腹腔镜辅助下根治性远端胃切除术44例,除1例中转开腹外,行D1+α淋巴结清扫6例,D1+β清扫2例,D2/D2+清扫35例.毕Ⅰ式胃肠道重建14例,毕Ⅱ式27例,Roux-en-Y 3例. 结果 43例成功进行腹腔镜手术.1例因胃左动脉周围淋巴结融合而中转开腹手术.手术时间(282.8±32.8)min,出血量(139.3±82.7)ml,清扫淋巴结(30.1±17.0)枚,肿瘤近残端(6.0±1.3)cm,远残端(6.4±1.1)cm.术后肛门排气时间(4.1±0.8)d,下床活动时间(3.2±0.8)d.无术后死亡,无吻合口漏,术后并发症6例均经内科治疗痊愈或好转.术后随访1～15月,平均6.8月,1例Ⅳ期患者腹腔复发伴trocar穿刺道转移. 结论腹腔镜胃癌根治术较传统开腹手术耗时长,能达到胃癌标准根治术(D2)的淋巴结清扫范围,且具有创伤小、出血少、安全、术后恢复快等优点.

Objective To explore the feasibility and the efficacy of laparoscopy-assisted radical distal gastrectomy with D2 regional lymphadenectomy. Methods A total of 44 cases of laparocopy-assisted radical distal gastrectomy were performed. Except for 1 case of conversion to open surgery, there were 6 cases of D1 +α lymphadenectomy, 2 cases of D1 +β lymphadenectomy, and 35 cases of D2/D2 + lymphadenectomy. The Billroth Ⅰ reconstruction was performed in 14 cases, the Billroth Ⅱ technique was performed in 27 cases, and the Roux-en-Y anastomosis, in 3 cases. Results Laparoscopy-assisted distal gastrectomy was carried out successfully in 43 cases, while a conversion to open surgery was required in 1 case due to the fusion of lymph nodes at the origin of the left gastric artery. The operative time was (282.8±32.8) min, the blood loss was 139.3±82.7 ml, the number of lymph nodes dissected was 30.1±17.0, and the lengths of proximal and distal margins to the tumor were (6.0±1.3) cm and (6.4±1.1) cm respectively. The postoperative time to passing flatus was (4.1±0.8) days, and the patients began to get out of bed at (3.2±0.8) days. No postoperative deaths or anastomotic fistula were noted. Postoperative complications occurred in 6 cases and were cured by medical treatment. Follow-up for 1~15 months (mean,6.8 months)revealed an abdominal recurrence with trocar tract implantation in a stage Ⅳ patient. Conclusions Although time consuming, laparoscopy-assisted distal gastrectomy with D2 lymphadenectomy is a safe and feasible procedure which achieves adequate oncological clearance and leads to quick postoperative recovery.