腹腔镜残胃癌切除术14例报告

Laparoscopic radical gastrectomy for gastric stump carcinoma:a report of 14 cases

目的探讨腹腔镜下残胃癌切除术的技术方法和临床疗效。方法回顾性分析第三军医大学西南医院2006年7月至2009年7月收治的14例残胃癌病人资料,分析手术的方式、方法、难点及技术要领,评价临床疗效。结果在腹腔镜下完成根治性D2残胃全切除术11例,姑息性残胃全切除术2例,中转开腹1例,均行Roux-en-Y方式重建消化道。腹腔镜手术平均用时(210±25)min,术中平均失血量(110±40)mL,清扫淋巴结平均(17.5±5.0)枚。术后不留置胃管,胃肠恢复时间平均(2.5±1.0)d,进食时间平均(2.5±1.0)d,下床活动时间平均(3.0±0.5)d。切口感染1例。随访时间6～36个月,1例发生肝脏转移死亡,1例腹膜转移死亡,1例合并红斑狼疮死亡,其余11例仍存活。结论残胃癌行腹腔镜手术切除技术上是可行的,创伤比开腹手术小,术后恢复快,近期疗效较好。

Objective To investigate the techniques and results of laparoscopic radical gastrectomy for gastric stump carcino,na （GSC）. Methods The clinical data of 14 cases of GSC admitted between July 2006 and July 2009 at the Southwest Hospital of the Third Military Medical University were analyzed retrospectively.Laparoscopic total gastrectomy were applied successfully in all the cases. The way, method ,difficulty and main points of the operation were analyzed. Moreover, its clinical results were evaluated. Results Eleven cases were completed successfully with laparoscopic radical gastrectomy, 2 cases with laparoscopic palliative gastreetomy and 1 case transfered to open surgery. Average operative time was （210±25）rains. Average blood loss was （110±40）mL and average number of lymph nodes dissected was 17.5± 5.0. Gastric tube was not detained routinely after the operation. Average postoperative time to passing flatula was （2.5± 1.0） d. The start of oral liquids was （2.5±1.0）d. The patients began to get out of bed at （3.0±0.5）d. Infection of incision occurred in 1 case postoperatively. The time to follow up was 6 to 36 months. Three patients were dead, 1 case with hepatic metastasis, 1 case with peritoneal metastasis and 1 case with dermatitis glandularis erythematosa. The other 11 cases were still in survival. Conclusion It is feasible for laparoscopic gastrectomy in the treatment for GSC. Compared with open surgery, laparosenpic radical gastrectomy for GSC is assioated with less invasivion and faster recovery. Furthermore, it has reeeived better short-term results.