手辅助腹腔镜与腹腔镜辅助和开腹胃癌根治性切除术的临床比较

Hand-assisted laparoscopic radical gastrectomy： comparison between laparoscopic and openapproach

目的探讨手辅助腹腔镜胃癌根治性切除术的可行性和技术路线。方法成都军区总医院全军普通外科中心胃肠外科自2010年6月至2011年5月对术前经胃镜活组织病理检查确诊为胃癌的42例患者实施了胃癌根治性切除术。其中手辅助腹腔镜手术（手辅助组）15例，腹腔镜辅助手术（腹腔镜组）16例，传统开腹手术（开腹组）11例。对3组手术方式及其结果进行比较分析。结果手辅助组、腹腔镜组和开腹组的手术时间分别为150-200、180。220和150-200min；腹腔镜操作时间分别为18-58和70-100min；手术平均切VI长度分别为6．8、5．6和13．5em；平均清扫淋巴结数目分别为17．6、15．1和16．4枚：术中平均出血量分别为228、278和427ml；手术后平均住院时间分别为9．9、10．8和12．4d；全部患者均未发生吻合口瘘、出血和胃瘫等手术并发症；开腹组发生切口感染1例。结论手辅助腹腔镜胃癌根治性切除术符合胃癌手术操作规范．更易于清扫淋巴结．可作为胃癌根治术的一种手术模式。

Objective To evaluate the short-term outcomes after hand-assisted laparoscopic radical gastrectomy. Methods Between June 2010 and May 2011, a series of 15 patients underwent hand-assisted laparoscopie gastrectomy （HG）, 16 patients underwent laparoscopic gastrectomy （LP）, and 11 patients underwent open gastrcctomy（OP）. Short-term outcomes included operative time, blood loss, lymph nodes harvested, and the length of incision were collected after operation. Results The operative time was 150-200 min in HG, 180-220 min in LP, and 150-200 rain in OP respectively. The time of laparoscopic procedure was 18-58 and 70-100 min respectively. The average incision length was 6.8 cm in HG, 5.6 cm in LP, and 13.5 cm in OP. The average number of lymph nodes harvested was 17.6, 15.1 and 16.4 respectively. The average estimated blood loss was 228 ml, 278 ml, and 427 ml respectively. The mean length of hospital stay was 9.9, 10.8, and 12.4 d. No anastomotic leakage, bleeding, or gastric paralysis were found. One wound infection case was found in OP. Conclusions Hand-assisted laparoscopic gastrectomy is in concordance with the standardized treatment protocol for gastric cancer. Lymph node dissection is easier by HG, therefore HG can be an alternative for the radical resection of gastric cancer.