腹腔镜辅助胃癌根治术:附54例报告

Laparoscope-assisted radical gastrectomy for gastric cancer:a report of 54 cases

目的探讨腹腔镜辅助胃癌根治术的安全性和可行性。方法对54例胃癌患者进行腹腔镜辅助下胃癌根治术,其中根治性全胃切除术12例,近端胃大部切除术18例,远端胃大部切除术24例;淋巴结清扫D1式29例,D2式25例。结果54例均成功完成腹腔镜手术。平均手术时间:全胃切除(164.4±38.7)min,近端胃切除(142.4±35.2)min,远端胃切除(149.1±35.4)min。平均术中出血量:全胃切除(164.6±80.1)mL,近端胃切除(149.5±94.7)mL,远端胃切除(152.5±87.7)mL。清扫淋巴结数平均(19.1±6.2)枚/例。术后平均胃肠功能恢复时间(3.5±0.7)h。术后发生吻合口出血2例,均经非手术治疗止血;无吻合口瘘、吻合口梗阻、十二指肠残端瘘等并发症。术后住院时间平均(9.2±1.7)d。结论腹腔镜辅助胃癌根治术安全、可行;只要严格遵守肿瘤的手术原则,腹腔镜辅助胃癌根治术能够保持肿瘤的根治性,同时能体现手术的微创性。

Objective To explore the safety and feasibility of laparoscope-assisted radical gastrectomy for gastric cancer. Methods Fifty-four cases of gastric cancer were selected to carry out laparoscope-assisted radical gastrectomy, including 12 radical total gastrectomies, 18 proximal gastrectomies, and 24 distal gastrectomies. Lymphonodes were dissected by D1 in 29 cases and D2 in 25 cases. Results All of the 54 operations were performed successfully. The average operative time was （ 164. 4 ± 38. 7 ） min in total gastrectomies, （ 142. 4 ±35. 2 ） min in proximal gastrectomies, and （ 149. 1± 35. 4 ） min in distal gastrectomies. The mean volume of bleeding was （ 164.6 ± 80. 1 ） mL in total gastrectomies, （ 149.5 ± 94.7） mL in proximal gastrectomies, and （152. 5 ± 87. 7 ） mL in distal gastrectomies. The average number of lymphonodes dissected was 19. 1 ± 6.5 per case. After operation, the mean time of passage of gas via anus was （3.7±0.7） d, and the mean length of hospital stay was （9.2 ±1.7） d. Two cases experienced postoperative anastomotic bleeding, and was controlled by conservative treatment. No other complications, such as anastomotie leakage, anastomotic obstruction, or duodenal stump leakage were experienced. Conclusions This results reveal that laparoscope-assisted radical gastrectomy is safe and feasible for gastric cancer. As long as the principles of cancer surgery are strictly followed, it can maintain radical tumor removal and exhibit the character of minimal invasion.