腹腔镜胃癌根治手术中的团队配合

Teamwork in Laparoscopic Radical Gastrectomy

目的探讨团队配合在腹腔镜胃癌根治手术中的重要性及技巧。方法对2008年1月-2008年10月32例腹腔镜胃癌根治临床的临床资料进行分析。主刀医生及扶镜助手,第一助手在相应的手术区域,采用基本固定的配合模式,分别完成胃结肠韧带、脾胃韧带、肝胃韧带的离断,小网膜囊的完整切除及各组淋巴结的清扫,并在体腔外完成病灶的切除,消化道的重建。结果32例均在腹腔镜下完成手术,远近端胃癌根治性切除术时间250-390 min,平均325 min。全胃根治性切除300-450 min,平均347min。术中出血量：远、近端胃癌根治性切除术50-250 ml,全胃根治性切除术60-350 ml,术中均未输血。所有标本切缘均阴性,清扫淋巴结13-35枚,平均21枚。术后排气时间24-72 h,平均38 h。进流质时间2-5 d,平均2.8 d。27例术后随访1-8个月,未见复发和转移,未发生切口和穿刺口种植。结论密切的团队配合是顺利完成腹腔镜胃癌根治手术的必要条件,对缩短手术时间,减少术中出血及保证根治效果具有重要意义。

Objective To discuss the importance and skills of teamwork in laparoscopic radical gastrectomy. Methods The operation data of 32 cases who underwent laparoscopic radical gastrectomy from January 2008 to October 2008 were analyzed and followed up. The lymph node dissection of each group, complete excision of the lesser omental bursa, disconnection of the gastrocolic ligament, gastrolienal ligament, and hepatogastric ligament were performed by the whole team with bascically fixed combining model used in corresponding operative regions. Reconstruction of the digestive tract and removal of the tumor were performed out of the body cavity. Results All the patients underwent laparoscnpic radical gastrectomy, including radical distal gastrectomy in 18 cases, radical proximal gastrectomy in 2 cases, and radical total gastrectomy in 12 cases, and D2 lymph nodes dissection,without conversion to open surgery. The operation time was 250 -390 minutes （mean, 325 minutes） in radical distal gastrectomy and radical proximal gastrectomy respectively, and 300 -450 minutes in radical total gastrectomy （mean, 347 minutes）. The blood loss was 50 -250 ml in radical distal gastrectomy and radical proximal gastrectomy respectively, and 60 -350 ml in radical total gastrectomy. No blood transfusion was needed. The number of harvested lymph nodes was 13 - 35 （ mean, 21 ）. The time to first flatus was 24 - 72 hours （mean, 38 hours） , and the time to liquid diet was 2 -5 days （mean, 2.8 days）. A 1- to 8-month postoperative follow-up revealed no recurrence or metastasis, neither port site implantation. No anastomotic leakage or other surgical-related complications occurred during the follow-up. Conclusions Close teamwork is the necessary condition for the successful accomplishment of laparoscopic radical gastrectomy. It has important significance in shortening operation time, reducing operative bleeding and guaranteeing the radical effect.