腹腔镜下胃近端癌根治术的探讨

Laparoscopic radical surgery for upper gastric cancer:A report of 53 cases

目的探讨腹腔镜下胃近端癌根治性手术的可行性及其效果。方法回顾性分析我们于2004年5月-2006年10月行腹腔镜下根治性胃近端癌手术53例的临床资料。其中，行D1^＋αβ淋巴结清扫6例，D2／D2^＋清扫47例。全胃切除术18例，近端胃大部切除术35例。结果本组有49例成功进行腹腔镜手术。中转开腹4例，中转率为7．5％。根治性近端胃切除术平均手术时间（215．8±22．8）min，全胃切除手术时间（289．8±35．8）min）平均出血量（139．34±82．7）ml；清扫淋巴结（28．9±11．0）枚；肿瘤近残端（3．6±1．3）cm，远残端（6．4±1．1）cm。术后肛门排气时间（3．1±0．9）d，下床活动时间（2．8±0．6）d。无术后死亡病例。吻合口漏1例及其它并发症7例均经内科治疗痊愈。术后随访2～31月，平均18．6月。因肿瘤复发死亡11例，另3例复发病人尚健在。结论腹腔镜胃近端癌根治术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、恢复快、并发症发生率低及减少开胸手术机会等优点。

Objective To explore the feasibility and safety of laparoscopic surgery for gastric cancers at the upper one third of the stomach. Methods Fifty-three laparoscopic procedures for upper gastric cancers were performed at our hospital from May 2004 to October 2006, including 18 proce- dures of total gastrectomy and 35 of proximal gastrectomy. D1 plus alpha or beta lymphadenectomy was performed on 6 cases,and D2 in 47 cases. Results Except for 4 cases of conversion to open surgery, the other 49 patients underwent laparoscopy-assisted proximal or total gastrectomy successfully. The mean operative time was（215.8 ± 22. 8） min for proximal gastrectomy and（289. 8 ± 35. 8） rain for total gas- trectomy,mean blood loss（139. 34 ± 82. 7） ml, and mean lymph nodes retrieved（28. 9 ± 11.0）. The proximal and distal tumor margins were（3. 6 ± 1.3） cm and（6.4 ± 1.1 ） cm, respectively, with all the margins free of cancer cells. The patients had a quicker recovery as indicated by first flatus time and time to ground activity. There was no postoperative death, with an acceptable morbidity rate. After a mean follow-up period of 18. 6 months, there were 10 deaths and 3 alive patients with recurrent diseases. Conclusion Laparoscopic proximal or total gastrectomy is feasible,safe and effective in cancer clearance for gastric cancers at the upper one third of the stomach, with the merits of microinvasiveness,less blood loss, quicker recovery, acceptable morbidity rate and decreased chance of conversion to thoracotomy.