腹腔镜辅助下胃癌根治术

Laparoscope-assisted radical gastrectomy for gastric cancer

目的探讨腹腔镜辅助下胃癌根治术加或不加联合脏器切除的手术方法的可行性。方法对20例行腹腔镜辅助下胃癌根治术的进展期胃癌患者的临床资料进行回顾性分析。结果腹腔镜辅助下全胃根治术4例,其中联合结肠切除3例,联合卵巢切除1例;根治性近端胃大部切除术4例,其中联合脾、胰体尾部分切除1例。根治性远端胃大部切除术12例,其中联合横结肠部分切除术1例。无中转开腹;平均手术时间:全胃切除380min(350～410min),近端胃切除236.2min(210～259min),远端胃切除273min(250～310min),全胃联合脏器切除410min(370～450min);术中平均出血量:全胃切除500mL(400～600mL),近端胃切除120mL(50～170mL),远端胃切除140mL(70～200mL),术中均未输血。术后患者平均胃肠功能恢复时间3.2d(2～4d),下床活动时间3.3d(3、4d),开始进流质时间3.9d(3～5d),近期疗效良好。无术中及术后并发症。结论腹腔镜辅助下胃癌根治术加或不加联合脏器切除手术技术可行,具有创伤小、恢复快的优点,可以取得和开腹手术相似的结果。远期疗效有待进一步观察。

[Objective] To explore the feasibility, method, and chnical outcomes of laparoscope-assisted radical gastrectomy with or without combined resection of other organs for gastric cancer. [Methods] The clinical data of 20 cases with advanced gastric treated with laparoscope-assisted radical gastrectomy were analyzed retrospectively. [Results] Laparoscope-assisted radical gastrectomy, total gastrectomy in 4 cases, among 3 with combined colectomy, 1 with ovariectomy; proximal gastrectomy in 4 cases, among lwith splenectomy plus distal pancreectomy; distal gastrectomy in 12 cases, among 1 with colectomy, respectively. Laparoscope-assisted surgery was successfully performed in all cases. There was not converted to abdominal opening. The average operative time for total gastrectomy, proximal gastrectomy, and distal gastrectomy was 380（350～410）min, 236.2（210-259）min, and 273（250～310）min, respectively, total gastrectomy with combined resection of other organs 410（370～ 450）min. The average blood loss in total gastrectomy, proximal gastrectomy, and distal gastrectomy was 500（400-600）mL, 120（50～170）mL, and 140 （70～200）mL respectively, being transfused. The average time for gastrointestinal function recovery, for the patients to stand up, and for the start of oral liquids was 3.2（2-4）d, 3.3（3-4）d, and 3.9（3-5）d after operation respectively. The postoperative outcomes were satisfactory. No comphcations were found. [Conclusion] Laparoscope-assisted radical gastrectomy with or without combined resection of other organs is safe, feasible, and minimally invasive and can achieve the same result of abdominal opening, but the long-term outcome is needed to be observed.