腹腔镜下胃癌淋巴结清扫及重建162例研究

Laparoscopic intracorporeal anastomosis of the gastrointestinal tract in D2 radical gastrectomy for gastric cancer: A retrospective study of 162 cases

目的探索与研究胃癌腹腔镜下清扫及重建技术。方法回顾性分析2009年7月至2012年11月收治的162例腹腔镜下D2清扫及重建患者的临床资料,统计分析其手术时间、手术出血量、淋巴结清扫个数及并发症发生率等多项指标。结果本组162例患者中160例成功实施胃癌腹腔镜下D2清扫及重建,2例中转开腹,其中73例行远端胃切除,89例全胃切除,无术中死亡发生。平均手术时间284(115～610)min,平均术中出血量235(80～1400)ml,平均淋巴结清扫28.3(6～57)枚;术后随访1～42个月(平均17.5个月),术后并发症率10.5%(17/162),其中主要并发症6例(3.7%),次要并发症11例(6.8%)。所有术后并发症均通过积极妥善处理后痊愈。结论胃癌腹腔镜下清扫及重建手术,有可能是胃癌患者外科治疗的一种选择。

Objective To investigate the skills of laparoscopic intracorporeal anastomosis of the gastrointestinal tract in D2 radical gastrectomy for gastric cancer. Methods From July 2009 to November 2012, 162 patients with gastric cancer underwent laparnseopic intraeorporeal anastomosis of the gastrointestinal tract during D2 radical gastrectomy. Clinical data were analyzed retrospectively, including operatiml lime, inlraoperative blood loss, number of harvested lymph nodes and postoperative complications. Results Among the 162 patients, 160 underwent a successful laparoscopie intracorporeal anastomosis of tbo gastrnintestinaI tract in D2 radical gastrectomy, and 2 underwent intraoperative eonversion to open surgery. In all Che patients, 73 were subjected to distal gastreetomy and 89 to total gastrectomy; no patient died during operation. The mean operation time was 284 （ 115 -610）minutes. The mean intraoperative blood loss was 235（80 - 1400） mL. The mean nmnber of harvested lymph nodes was 28.3 （6 - 57）. Duodenal stump leakage plus bleeding, abdominal bleeding and duodenal anastomosis bleeding were observed during a follow-up of average 17.5（ 1 --42） months. Totally, the incidence of complications was 10.5% （17/162）. Six （3. 7% ）patients had major eompliealions and 11 （6. 8% ）had minor complications. All of the eomplitations were cured by comprehensive treatments. Conclusions Laparoscopic intraeorporeal anastomosis of the gastrointestinal tract in D2 radical gastreetomy is reasonable, safe and technically feasible, and is a promising surgical option for patients with gastric cancer.