进展期胃癌腹腔镜分期的临床研究

Clinical investigation on laparoscopic staging of advanced gastric cancer

目的探讨腹腔镜检查对进展期胃癌分期的价值。方法 2007年1月～2010年12月收治的进展期胃癌患者41例,在全麻下行腹腔镜分期。结果腹腔镜T分期与术后病理检查结果符合率为92.7%,术前临床T分期与术后病理检查结果符合率为62.5%。腹腔镜分期显著优于临床分期P<0.05。在41例术前临床分期均未发现腹膜转移的病例中,腹腔镜探查发现有腹膜转移(P1-P3)者9例,腹腔镜对腹膜转移的评估显著优于临床分期P<0.05。3例广泛腹腔种植转移的患者避免了开腹手术。结论作为常规检查手段的一种补充,腹腔镜检查能对进展期胃癌进行准确的诊断和分期,有助于手术决策制定及估计治疗结果与预后,避免不必要的剖腹探查。

Objective To evaluate the clinical value of laparoscopic staging before gastrectomy.Methods 41 patients with clinical T3 or T4 gastric cancer expected to undergo curative resection,based on conventional preoperative diagnostic methods underwent staging laparoscopy from January 2007 to December 2010.Results The coincidence rate of tumor stage between laparoscopy and autopsy was 92.7%,The coincidence rate of tumor stage between preoperative clinical and postoperative autopsy was 62.5%.Laparoscopic staging was superior to clinic staging.laparoscopic staging for peritoneal metastases was superior to clinic staging,because laparoscopy found 9 cases of peritoneal metastases which were considered no metastasis according to preoperative clinic staging.Three exploratory laparotomy were avoided because numerous metastases to the distant peritoneum were discovered after laparoscopic staging.Conclusion Laparoscopy is a safe and useful technique in the staging of gastric cancer and offers a better therapeutic scheme.