腹腔镜辅助远端胃癌根治术的临床应用

Clinical application of laparoscopic distal gastrectomy for gastric cancer

目的探讨腹腔镜远端胃癌根治术的可行性及手术方法。方法行腹腔镜远端胃癌根治术15例,D1清扫3例,D2/D2^＋12例。全部病例均行毕Ⅱ式胃空肠吻合。结果15例成功进行腹腔镜手术。手术时间平均（218.6±31.6）min,术中出血量平均（132.4±21.3）ml,清扫淋巴结平均（33.4±13.6）个。肿瘤近端切缘（6.6±0.9）cm,远端切缘（5.4±0.6）cm,术后肛门排气时间平均（3.5±0.6）d,无手术死亡,无吻合口漏,术后并发肺部感染1例,经治疗后痊愈。术后随访1-10个月,无肿瘤复发或转移。结论腹腔镜远端胃癌根治术能达到与开腹胃癌标准根治术（D2）的淋巴结清扫范围及肿瘤切缘,且具有创伤小、出血少、术后恢复快等优点。

Objective To investigate the feasibility and operation method of laparoscopic distal gastrectomy for gastric cancer. Methods Fifteen cases of gastric cancer were subjected to laparoscopic distal gastrectomy：D1 lymphadenectomy on 3 cases and D2/D2^ ＋ lymphadenectomy on 12 cases. All cases received Billroth Ⅱ reconstruction. Results Laparoscopic distal gastrectomy was carried out in 15 cases. The operative time was （218.6 ± 31.6） rain, the blood loss was （132.4 ± 21.30） ml, the number of lymph nodes dissected was （33.4 ± 13.6） ,and the lengths of proximal and distal margins to the tumor were （6.6 ± 0.9） cm and （5.4 ± 0.6） cm respectively. The postoperative time of passage of gas by anus was （3.5 ± 0.6） days. No postoperative deaths or anastomotic fistulas were found. Postoperative lung infection occurred in 1 case and cured by medical treatment. Follow- up for 1-10 months revealed no recurrence or implantation. Conclusion Laparoscopic radical distal gastrectomy is a safe and feasible procedure which achieves the same cancer clearance as open surgery and leads to quick postoperative recovery.