无瘤技术在腹腔镜辅助下进展期胃癌根治术中的应用体会

Experience of tumor-free technology of laparoscopy-assisted radical gastrectomy for advanced gastric cancer

目的:探讨特有的无瘤技术在腹腔镜辅助下进展期胃癌根治术中应用的安全性及可行性。方法:2006年4月～2010年6月,对66例进展期胃癌患者实施腹腔镜辅助下胃癌根治术,在遵循肿瘤根治术原则下实施无瘤技术以减少或防止肿瘤细胞的脱落、种植和播散等。结果:66例手术均获成功。手术时间:远端胃癌根治术平均280(220～340)min,近端胃癌根治术平均269(215～325)min,3例根治性全胃切除术手术时间分别为340 min、370 min、410 min。平均切口长度6.0(5.2～9.0)cm。术中出血量:腹腔镜远端胃癌根治术平均160(100～250)mL,腹腔镜近端胃癌根治术平均200(90～320)mL,3例腹腔镜根治性全胃切除术出血量分别为200 mL、350 mL、400 mL。清扫淋巴结:远端胃癌根治术平均21(15～31)枚,近端胃癌根治术平均22(17～28)枚,3例根治性全胃切除术分别为25、29、35枚。65例术后随访3～48个月(<1年21例,1～2年19例,>2年25例),均未见切口及戳孔肿瘤种植转移。结论:在严格掌握手术入选标准及术中行标准的根治范围的前提下,腹腔镜辅助下进展期胃癌根治术应用其特有的无瘤技术安全可行,可取得良好的近期疗效。

Objective： To explore the safety and feasibility of using the special tumor-free technology in laparoscopic assisted radical gastrectomy for advanced gastric cancer. Methods： A total of 66 patients with advanced gastric cancer were received laparoscopic assisted radical gastrectomy from April 2006 to June 2010. During the operation,following the princi- ple of radical resection of carcinoma, tumor-free technique was used to prevent or reduce the tumor cells detachment, im- plantation and metastasis. Results： 66 cases were carried out successfully. The mean operation time was 280 （ 220 ~ 340） min for radical resection of distal gastric cancer,269 （215 - 325 ） min for radical resection of proximal gastric cancer, radical total gastrectomy operation time was 340 min,370 min, 410 min in 3 cases. The average incision length was 6.0 （5.2 ~ 9. O） cm. The mean blood loss was 160（ 100 -250） mL in distal gastrectomy,200（90 -320） mL in proximal gastrectomy, laparoscopic radical total gastrectomy blood loss was 200 mL,350 mL,dO0 mL in 3 cases. The mean number of harvested lymph nodes was 21 （15 ~ 31 ） in distal gastrectomy,22 （17 -28 ） in proximal gastrectomy, the number of harvested lymph nodes was 25,29,35 in 3 cases of radical total gastrectomy. After 65 surgery patients were followed up for 3 to 48 months （ 〈 1 year in 21 cases, 1 to 2 years in 19 cases, 〉2 years in 25 cases） ,all patients were not showed tumor inplantation and metastasis of incision and puncture. Conclusion：After strictly following the surgical indications and standard scope for radical gastrectomy, in laparoscopic assisted radical gastrectomy using the special tumor^free technology is safe and feasible ,can achieve good short term effects.