腹腔镜近端胃大部切除7例体会

Laparoscopic proximal gastrectomy:a report of 7 cases

目的：探讨腹腔镜近端胃大部切除的方法、效果及可行性。方法：回顾分析腹腔镜胃大部切除7例的临床资料。结果：7例均在腹腔镜下成功完成手术，平均用时278min（237～356min），术中平均出血量120ml（60～300ml），病理检查低分化腺癌4例，中分化腺癌2例，高分化腺癌1例，均未见残端肿瘤残余，切缘距肿瘤边缘5．9cm（3．5～8．5cm），平均清扫淋巴结14．2个（7～21个）。术后患者第1次排气时间34．2h（18～69h），第1次离床活动时间42．7h（38～77h），术后24h即鼓励患者少量喝水，未出现腹胀或呕吐。术后平均住院8．4d（7～11d），未进行化疗，随访2～13月，无复发。结论：腹腔镜近端胃大部切除术安全、可行，能够达到与开腹手术相当的根治效果，具有患者创伤小，术后康复快等优点。

Objective ：To explore the method,effect and feasibility of laparoscopic proximal gastrectomy. Methods ：The clinical data of seven cases were analyzed retrospectivecy. Results： All cases were operated with laparoscopic method successfully. The mean operative time was 278min （237-356min）. The mean blood loss was 120ml（60-300ml）. Pathology results included 4 cases of low differential adenoma,2 cases of middle differential adenoma and 1 case of high differential adenoma. The mean distance from incision edge to the tumour was 5.9cm（3.5-8.5cm）. The mean number of lymph nodes dissected was 14.2（7-21 ）. Time of bowel pass was 34.2h（ 18- 69h）. Time of bedside movement was 42.7h（38-77h）. Patients were encouraged to drink water 2dh after operation,no vomitting was observed. The mean hospitalization was 8.4d （7-11 d）. No recurrence was observed during the 2-13 months follow-up. Conclusions： Laparoscopic proximal gastrectomy is a safe procedure and matches the results of open operation. It has the merits of less trauma and rapid recovery.