腹腔镜辅助远端胃癌根治术16例报告

Laparoscopy-assisted radical distal gastrectomy for gastric cancer:A clinical report of 16 cases

目的探讨腹腔镜辅助远端胃癌根治术的可行性及安全性。方法2006年10月至2007年11月下行腹腔镜远端胃癌根治术16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16例成功进行腹腔镜辅助下胃癌根治术，中位手术时间5h（4．5～7h）。术中出血量中位数为250ml（150—700m1）。肿瘤近端切缘6am（5．5～7cm），远端切缘5cm（5～6cm），术后肛门排气时间平均3d（2—4d），无手术死亡，无吻合口漏，术后并发肺部感染1例，术中脾损伤1例。清扫淋巴结数目的中位数为16枚（12～24枚）。术后胃肠功能恢复时间的中位数4d（3—6d）。16例随访2～8个月（中位时间5个月），无肿瘤复发和转移。结论腹腔镜远端胃癌根治术可行性强，且具有创伤小、出血少、术后恢复快等优点。

Objective To investigate the feasibility and safety of laparoseopic distal gastreetomy for gastric cancer. Methods Sixteen cases of gastric cancer were subjected to laparoscopic distal gastrectomy ： D1 lympha denectomy on 3 eases and D2/D2 lymphadenectomy on 13 cases. All cases received Billroth Ⅱ reconstruction. Results Laparoseopie distal gastrectomy was carried out in 16 cases. The median operative time was 5 h （ range 4. 5-7 h）. The median blood loss was 250 ml （ range,150-700 ml）. One patient received blood transfusion during the operation. Intraoperative spleen injury occurred in one case. The median number of harvested lymph nodes was 20 （ range, 14-33 ）. No patient died after the surgery. The median time for gastrointestinal function recovery was 4 d （ range 3-6 d）. One patient developed gastroparafysis after the operation and was cured by conservative therapy. One of the patients had bleeding of the jejunal pouch after total gastrectomy. No anastomotic leakage and lung infection occurred after the surgery. And no recurrence or metastasis was found during a 2 to 8 month follow-up （median,5）. Conclusion Laparoscopic radical distal gastrectomy is a feasible procedure and leads to quick postoperative recovery.