腹腔镜进展期胃癌D_2根治术手术路径的探讨

Discussion of surgical approach for laparoscopic D_2 radical operation for advanced gastric cancer

目的:探讨腹腔镜胃癌D2根治术的手术路径选择。方法:回顾分析为42例患者行腹腔镜胃癌D2根治术的临床资料。结果:42例手术均获成功,无一例中转开腹;其中18例行远端胃大部切除胃空肠Roux-en-Y吻合术,16例行全腹腔镜下远端胃大部切除胃十二指肠毕Ⅰ吻合术,8例行根治性全胃切除食管空肠Roux-en-Y吻合术。手术时间160～310 min,平均(218±34)min;术中出血量30～280 ml,平均(70±42)ml;清扫淋巴结数量16～32枚,平均(26±8)枚;术后分期Ⅰb期7例,Ⅱ期27例,Ⅲa期8例。结论:术者合理站位并选择合理正确的技术路线使腹腔镜胃癌D2根治术操作简便、易行。

Objective：To investigate the surgical approach of laparoscopic D2 radical operation for gastric cancer.Methods：Clinical data of 42 patients who underwent laparoscopic D2 radical resection for gastric cancer from Dec.2011 to Oct.2012 were analyzed retrospectively.Results：All operations were conducted successfully,without conversion to laparotomy.Of which,18 cases underwent distal gastrectomy and Roux-en-Y gastrojejunostomy,16 cases underwent totally laparoscopic distal gastrectomy and BillrothⅠgastroduodenostomy,8 cases underwent total gastrectomy and Roux-en-Y esophagojejunostomy.The operation duration was 160-310 min,average（218±34） min.The intraoperative blood loss was 30-280 ml,average（70±42） ml.The number of dissected lymph nodes was 16-32,average（26±8）.The TNM classification of the tumor were 7 cases of stage Ⅰb,27 cases stage Ⅱ and 8 cases of Ⅲa.Conclusions：The rational position of operator and properly designed approach can make the operation more feasible and convenient.