手助腹腔镜行胃癌D_2根治术的手术安全与技术路径探讨

Surgical safety and technical approach of hand-assisted laparoscopic D_2 radical operation for gastric cancer

目的:探索手助方式在腹腔镜胃癌D2根治术中应用的可行性和技术路径。方法:回顾性分析自2010年12月—2011年5月的胃癌患者30例的临床资料,采用自行设计的手术路径,实施手助腹腔镜胃癌D2根治术治疗。结果:成功施行手辅助腹腔镜胃癌D2根治术29例。其中根治性全胃切除术15例,根治性近端胃切除术3例,根治性远端胃切除术11例。全程手术时间150～210 min(平均177 min);手术切口长度6～7 cm(平均6.86 cm);术中出血80～600 mL(平均228 mL)。手术后病理检出淋巴结数11～35枚(平均16.79枚)。29例均没有发现手术切缘癌残留。TNM分期:I期1例,II期2例,III A期8例,III B期6例,IV期12例。术后并发胃无力症1例。全组因术中出血中转开腹手术1例。结论:笔者自行设计的手辅助腹腔镜技术路径能够满足胃癌D2根治术的手术操作规范需求,安全、可行,并有可能成为一种新的胃癌手术模式。

Objective： To investigate the feasibility and surgical approach of hand-assisted laparoscopic D2 radical operation for gastric cancer. Methods： The clinical data of 30 patients with gastric cancer admitted to our center from December 2010 to May 2011, who underwent hand-assisted laparoscopic D2 radical gastrectomy by self-designed surgical approach, were retrospectively analyzed. Results＂ Hand-assisted laparoscopic D2 radical gastrectomy was successfully performed in 29 patients, of whom, radical total gastrectomy was performed in 15 cases, proximal subtotal gastrectomy in 3 cases and distal subtotal gastrectomy in 11 cases. The whole time of surgery was 150-210 （average of 177） min, the surgical incision length was 6-7 （average of 6.86） cm, and the intraoperative blood loss was 80-600 （average of 228） mL. The number of involved lymph nodes detected by postoperative pathology was 11-35 （average of 16.79）, and no residual tumor was noted in the surgical margin of any of the 29 cases. The TNM classification of the tumors were one case of stage I, 2 cases of stage II, 8 cases of stage IliA, 6 cases of stage IIIB and 12 cases of stage IV, respectively. Gastric atony occurred in one case after surgery. One patient was converted to open surgery due to massive intraoperative bleeding. Conclusion： Our properly designed appoach of hand-assisted laparoscopic operation can meet the operating criterion of D2 radical gastrectomy. It is safe and feasible, and may probably become a new procedure of gastric cancer surgery.