手助腹腔镜胃癌根治术102例近期疗效分析

Clinical investigation of short-term effect of hand-assisted laparoscopic radical gastrectomy for 102 cases of gastric cancer

目的：评价手助腹腔镜胃癌根治术的近期疗效。方法：回顾分析2010年12月至2012年7月为102例患者行手助腹腔镜胃癌根治术的临床资料及随访记录，统计手术效果相关指标，结果以（均数±标准差）表示，分析术后并发症及随访期间患者生存状况。结果：102例患者中2例中转开腹，中转率1．96％；53例行全胃切除术，39例行远端胃切除术，8例行近端胃切除术；其中4例联合胆囊切除术，2例联合左肝外叶部分切除术，1例联合行胰体尾部分切除＋脾切除术。手术切口平均（6．81±0．29）cm：术中出血量平均（244．10±117．02）ml；手术时间平均（172．28±24．02）ml；病理检获淋巴结数量平均（17．10±5．70）枚；术后平均住院（10．20±3．84）d。无手术相关死亡病例，9例发生并发症，并发症发生率9％（9／100）。术后随访1～12个月，6例失访，失访率6％，3例发生可能与手术操作有关的继发性病变，发生率3．19％（3／94）。结论：手助腹腔镜胃癌根治术经过较系统的临床实践可取得满意的手术效果，且手术安全可靠、近期疗效良好，但远期疗效尚需进一步观察。

Objective： To preliminarily evaluate of the short-term effect of hand-assisted laparoscopic radical gastrectomy. Methods ： One hundred and two patients with gastric cancer were operated by hand-assisted faparoscopic radical gastrectomy. Their clin- ical data and following up records were retrospectively analyzed. The length of the incision, operative time, blood loss, lymph node num- ber, hospital stay, postoperative complications and live station after operation were evaluated. Results ： Conversion to laparotomy was nee- ded in 2 cases （ conversion rate was 1.96% ）. 100 cases,including 53 total gastrectomy,39 distal gastrectomy, and 8 proximal gastrecto- my,were operated successfully. 4 cases were combined with cholecystectomy,2 cases were combined with hepatic left lateral lobectomy, and 1 case was operated with splenectomy and pancreatic body and tail resection. Average length of the incision was （6.81 ± 0.29 ） cm, blood loss was （244.10 ± 117.02） ml,operative time was （ 172.28 ± 24.02） ml, number of removed lymph node was （ 17.10 ± 5.70） ,postoperative hospital stay was （10.20±3.84） d. Postoperative complication rate was 9% , and no mortality case was tound. The follow-up period after operation was between 1 and 12 months. 6 cases （6%） were lost. And 3 cases of secondal＇y disease were found （3.19% ,3/94） , which might related with operating manipulation. Conclusions ： Hand-assisted laparoscopic radical gastrectomy for gastric cancer is able to obtain an approving surgical result, through systematically clinical practice. The operation is safe and relia- ble, the short-term outcome is favorable, but the long term outcomes still need further investigation.