腹腔镜辅助胃癌根治术24例

A Report of 24 Cases of Laparoscopic-assisted Radical Gastrectomy

目的探讨腹腔镜辅助胃癌根治术的效果。方法 2009年1月～2011年12月,行腹腔镜辅助根治性胃切除术24例。腹腔镜下探查腹腔、清除大网膜及预定范围的淋巴结,通过上腹部小切口完成胃肿瘤切除和胃肠重建。结果中转开腹手术1例。余23例完成腹腔镜手术,其中根治性全胃切除术6例,近端胃大部切除术3例,远端胃大部切除术14例。手术时间全胃(171.0±32.5)min,近端胃130、185及210 min,远端胃(137.2±40.2)min。术中出血量:全胃(260±80)ml,近端胃190、220、250 ml,远端胃(190±50)ml。清除淋巴结(18.4±4.3)枚。术后排气时间(1.4±0.8)d。术后住院时间(12.0±3.4)d。术后随访12～24个月,平均16.3月。复发率21.7%(5/23)。结论腹腔镜胃癌根治术可行、可靠,能够达到与开腹手术相当的根治效果,且具有创伤小、术后恢复快等优点。

Objective To discuss the efficacy of laparoscope-assisted radical gastrectomy for gastric cancer. Methods From January 2009 to December 2011, 24 patients with gastric cancer underwent laparoscopy-assisted radical gastrectomy. After exploring the abdominal cavity, removing the greater omentum and expected lymph nodes via laparoscopy, we resected the gastric tumor and rebuilt gastric intestine via a small midline upper abdominal incision. Results Of the 24 cases, 1 case was converted to open surgery and the other 23 cases went through laparoscopy-assisted surgery, including 6 cases of total radical gastrectomy, 3 cases of proximal gastrectomy, and 14 cases of distal gastrectomy. The average operation time was （171.0 ± 32.5） rain in total gastrectomy, 130, 185 and 210 min in proximal gastreetomy, and （ 137.2 ±40.2） rain in distal gastrectomy. Blood loss： （260 ± 80） ml in total gastrectomy, 190,220 and 250 ml in proximal gastreetomy respectively and （190 ± 50） ml in distal gastrectomy. The average number of lymph nodes dissected was 18.4 ± 4.3 per case. The average time of first postoperative flatus was （ 1.4 ± 0.8 ） d and the mean time of hospital stay was （12.0± 3.4） d. All cases were followed up for 12-24 months, with an average of 16.3 months. The rate of postoperative recurrence was about 21.7% （5/23）. Conclusions Laparoscope-assisted radical gastrectomy is safe and feasible for gastric cancer with minimal invasion and quick postoperative recovery. It has similar effects as compared with open surgery in curing the disease.