腹腔镜下胃癌全胃切除术的临床应用

Clinical application of laparoscopic total gastrectomy for gastric cancer

目的探讨腹腔镜下胃癌全胃切除术的可行性和效果。方法回顾性分析本科行腹腔镜下全胃切除术45例患者的资料。结果39例成功完成手术,其中腹腔镜根治性全胃切除37例,姑息性全胃切除2例;中转开腹全胃切除6例,其中根治性全胃切除3例,姑息性全胃切除3例。手术时间（335±45）min,术中出血量（270±150）ml,平均清扫淋巴结（35.6±12.2）枚,术后患者胃肠恢复平均时间（4.5±1.2）d,术后距下床活动时间（4.0±1.5）d,4例出现手术相关并发症,术后近期效果良好。结论腹腔镜胃癌全胃切除术安全、可行,能够达到与开腹手术相当的根治范围,具有创伤小、术后恢复快等优点。

Objective To investigate the feasibility, methodology and effect of laparoscopic total gastrectomy for gastric cancer. Methods Forty-five cases with gastric cancer received laparoscopic total gastrectomy. Methods and efficacy of the operation were evaluated postoperatively. Results A total of 39 cases underwent successful surgery under laparoscope, including 37 cases with laparoscopic radical gastrectomy and two with laparoscopic palliative gastrectomy. The other six cases were converted to open surgery, including three cases with radical gastrectomy and three with palliative gastrectomy. The mean operation time, intraoperative blood loss, the number of dissected lymph nodes, the time to gastrointestinal recovery, postoperative eating time, and the time for out-of-bed activity were （335±45） min, （270±150） ml, 35.6±12.2, （4.5±1.2） days, （4.5±1.3） days and （4. 0 ± 1.5） days, respectively. The postoperative outcomes were satisfactory except for four cases with complications. Conclusion Laparoscopic total gastrectomy for gastric cancer is safe and feasible, has advantages of minor trauma and fast postoperative recovery and can achieve the same result of open surgery.