完全腹腔镜下进展期远端胃癌根治术的临床体会(附26例报道)

Clinical Experience on Laparoscopic Radical Surgery in Patients with Advanced Distal Gastric Cancer(Report of 26 Cases)

目的总结完全腹腔镜下进展期胃癌根治术的临床体会。方法回顾性分析我科2005年8月至2010年5月期间对26例进展期胃癌患者行完全腹腔镜远端胃癌根治术的临床资料。结果所有患者均成功在腹腔镜下完成整个手术,无中转开腹。手术时间为270～450 min,（283.2±27.6）min;术中出血为80～350 ml,（178.4±67.4）ml。术后患者胃肠功能恢复时间为2～4 d,（2.8±1.2）d;下床活动时间为1～3 d,（1.5±0.4）d;进流质饮食时间为3～4 d,（3.5±1.4）d;术后住院时间为7～13 d,（10.0±2.6）d。清扫淋巴结为11～34枚,（17.8±7.3）枚。所有病例切缘均为阴性,近端切缘与肿瘤距离为5～12 cm,（7.0±2.1）cm;远端切缘与肿瘤距离为4～8 cm,（5.5±1.8）cm。术后所有患者均获随访,时间为3～48个月,平均18.5个月,2例低分化腺癌患者分别于术后13和18个月复发并转移死亡,其余患者未发现复发、转移。结论完全腹腔镜下远端胃癌根治术是安全、可行的,但其优越性相对于开腹手术尚需大量的临床资料来证明。

Objective To summarized the clinical experience on laparoscopic radical surgery in patients with advanced distal gastric cancer.Methods The clinical data of 26 patients with advanced distant gastric cancer undergoing laparoscopic gastrectomy were retrospectively analyzed.Results Laparoscopic distal gastrectomy was performed successfully in all patients.The operation time was（283.2±27.6） min（270-450 min） and the blood loss was（178.4±67.4） ml（80-350 ml）.The time of gastrointestinal function recovery was（2.8±1.2） d（2-4 d）,out of bed activity time was（1.5±0.4） d（1-3 d） and liquid diet feeding was（3.5±1.4） d（3-4 d）.The hospital stay was（10.0±2.6） d（7-13 d）.The number of harvested lymph nodes was 11 to 34（17.8±7.3）.The distance from proximal surgical margin to tumor was（7.0±2.1） cm（5-12 cm） and the distance from distal surgical margin to tumor was（5.5±1.8） cm（4-8 cm）,thus surgical margins were negative in all samples.All patients were followed up for 3-48 months（mean 18.5 months）,two patients with poorly differentiated adenocarcinoma died of extensive metastasis in 13 and 18 months,respectively,and other patients survived well.Conclusions Laparoscopic radical gastrectomy with D2 lymphadenectomy for advanced gastric cancer is safe and feasible.However,the advantage of laparoscopic technique over the conventional open surgery requires further study.