腹腔镜胃癌全胃切除术

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、方法和效果。方法回顾性分析行腹腔镜下全胃切除术的63例胃癌患者的临床资料，探讨手术方法，观察术后疗效。结果腹腔镜下根治性全胃切除52例，姑息性全胃切除5例。前期45例在小切口直视下行食管空肠吻合，后期12例在腹腔镜下行食管空肠吻合。中转开腹6例。手术用时（312±35）min，术中出血量（190±50）ml，清扫淋巴结（32±7）枚，术后患者胃肠功能恢复时间（4．0±1．2）d，进食时间（4．5±1．5）d，下床活动时间（4．0±1．5）d。5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，创伤小，术后恢复快，能够达到与开腹手术相当的根治范围。

Objective To investigate the feasibility, method and result of laparoscopic total gastrectomy for gastric cancer. Methods Clinical data of 63 cases of gastric cancer treated with laparoscopic total gastrectomy were analyzed retrospectively. Results In this study, 52 cases underwent laparoscopic radical total gastrectomy and 5 cases did laparoscopic palliative total gastrectomy. The procedure was hand assisted in the first 45 cases for fashoning esophagojejunostomy through a small incision. In six cases the procedure was converted to open surgery. The operative time was （312 ±35） min, the blood loss was （ 190 ±50） ml, the number of lymph nodes dissected was （32 ±7）. It began to pass flatus（4. 0 ± 1.2） days postoperatively. It was （4. 5 ± 1.5） days to start oral liquids. Patients were up and about on （4. 0 ± 1.5 ） days postoperatively. Minor postoperative complications occurred in 5 cases. Conclusion Laparoscopic total gastrectomy for gastric cancer is safe, feasible, less traumatic and of fast postoperative recovery.