双镜联合治疗早期胃癌的临床体会

The clinical experience of the treatment of early gastric cancer by combined laparoscopy and gastroscopy

目的:探讨胃镜、腹腔镜双镜联合治疗早期胃癌的安全性与可行性。方法:回顾分析近6年双镜联合治疗78例早期胃癌患者的临床资料。胃体、远端胃肿瘤非溃疡患者行内镜黏膜下剥离术,近端胃及胃体、远端胃肿瘤合并溃疡患者行双镜联合下腹腔镜胃楔形切除术。标本送快速病理检查。结果:为早期胃癌浸润至黏膜下层及肌层、伴有脉管癌栓、肿瘤直径>20 mm、低分化腺癌(包括印戒细胞癌)的30例患者行腹腔镜胃癌D2根治术,5例近贲门或幽门部位肿瘤患者行单纯胃大部切除术,43例患者仅行内镜黏膜下剥离术或单纯胃楔形切除术。根治患者术后淋巴结转移占全部病例的11.5%,术后均无并发症发生,患者痊愈出院。结论:双镜联合治疗早期胃癌安全、患者创伤小、康复快、疗效确切,更加体现了微创优势,避免了部分患者不必要的根治切除甚至全胃切除的痛苦,值得临床推广。

Objective：To explore the safety and feasibility of the combined laparoscopic-gastroscopic method to treat early gastric cancer. Methods：The clinical data of 78 patients of early gastric cancer who received combined laparoscopic-gastroscopic therapy in recent 6 years were analyzed retrospectively. Patients of gastric body and distal gastric tumor without ulcer received endoscopic submucosal dissection,and patients of proximal gastric and gastric body or distal gastric tumor with ulcer received laparoscopic gastric wedge resection with combined laparoscopic-gastroscopic method. Fast pathologic examinations were made after resection. Results：Thirty cases of early gastric cancer infiltrating through the submucosa and muscularis, accompanied by vascular tumor emboli ,with tumor diameter 〉 20 mm ,or poorly differentiated adenocarcinoma （including signet ring cell carcinoma） received laparoscopic D2 radical resection ,5 ca- ses with the tumor near cardia or pylorus received simple subtotal gastrectomy, the rest 43 patients only needed endoscopic submucosal dissection or stomach wedge resection. Patients with lymph node metastasis after lymph nodes cleaning accounted for 11.5% of all the cases, the same as the other scholars＇ research. All patients recovered smoothly without postoperative complications. Conclusions：Com- bined laparoscopic-gastroscopic method in the treatment of early gastric cancer is of safety, small trauma, quick recovery, and exact curative effect,which embodies the advantages of minimal invasion, avoids unnecessary pain from the radical resection or total gastrectomy. It is worth clinical application and generalization.