腹腔镜辅助远端胃癌根治术23例临床分析

Clinical analysis of laparoscopic assisted distal radical gastrectomy for 23 cases

目的探讨腹腔镜辅助远端胃癌根治术的安全性、可行性和治疗效果。方法施行腹腔镜辅助远端胃癌根治术23例，其中D1±α／D1±β淋巴结清扫术3例，D2淋巴结清扫术20例。全部病例均行毕I式胃肠吻合术。结果23例均成功完成腹腔镜手术。平均手术时间（205±38）min，平均术中出血量（105±66）ml，平均清扫淋巴结数（19．7±6．2）枚／例，术后平均胃肠功能恢复时间（3．5±1．2）d，恢复流质饮食时间（4．9±0．9）d，平均住院时间（10．2±2．7）d。无吻合口瘘、吻合口梗阻等并发症发生，术后发生上消化道出血1例，经保守治疗后痊愈。随访1～12个月，无肿瘤复发或转移。结论腹腔镜辅助远端胃癌根治术安全可行，术后近期疗效满意，有望在快速康复外科理念的指导下进一步提高近期疗效。

Objective To investigate the safety, feasibility and results of laparoscopic assisted distal radical gastrectomy for gastric cancer. Methods Twenty-three cases of gastric cancer were subjected to laparoscopic assisted distal radical gastrectomy,D1＋α/D1＋β lymphadenectomy on 3 cases and D2 lymphadenectomy on 20 cases. All cases received Billroth I reconstruction. Results Laparoscopic assisted distal radical gastrectomy was carried out in all cases successfully. The mean operative time was （205 ± 38） min,mean blood loss was （105 ± 66） ml and mean number of lymph nodes dissected was 19.7 ± 6.2 each case. The mean postoperative time of recovery of bowel function was （3.5 ± 1.2） d, mean postoperative time of liquid intake was （4.9 ± 0.9） d and mean hospitalization was （10.2 ± 2.7） d. No postoperative death or anastomotic fistula was found. Postoperative upper gastrointestinal bleeding occurred in 1 case and was cured by conservative treatment. Follow-up for 1-12 months revealed no recurrence or metastasis. Conclusions Laparoscopic assisted distal radical gastrectomy is a safe and feasible procedure with satisfactory short-term outcomes.Moreover,the short-term outcomes may be improved if the patients are treated under the notion of fast track surgery.