腹腔镜胃癌D2根治术无瘤技术的临床应用研究

The study of clinical application of laparoscopic D2 radical gastrectomy for gastric cancer tumor free technology

目的探讨并研究腹腔镜下行胃癌全胃切除(D2)根治术中无瘤技术的临床应用效果。方法选取2010年4月至2013年4月收治的进展期胃癌患者共42例作为研究对象,所有患者均行腹腔镜下胃癌根治术,观察并记录患者手术疗效、病理结果及随访情况,总结并分析术中无瘤技术的应用效果。结果所有患者均成功完成腹腔镜手术及术中的淋巴结清扫,无吻合口瘘、十二指肠残端瘘、吻合口梗阻等并发症发生。共清扫12组淋巴结平均(3.80±1.25)枚,其中癌转移平均为(1.30±0.13)枚,所有患者肿瘤近、远残端病理检查均未发现癌细胞。术后随访患者均健康生存,复查增强CT等均未发现肿瘤复发、远处转移等情况。结论腹腔镜下行胃癌根治术在术中严格遵守无瘤原则,能够获得令人满意的手术近期效果,而其远期效果尚需进一步多中心大宗病例的随机对照研究结果。随着腹腔镜技术不断发展、抑制肿瘤的药物研制、无瘤技术的改善,腹腔镜下行D2胃癌根治术的应用会有更为广阔的临床应用空间。

Objective To explore and study of laparoscopic D2 gastric cancer radical effect of clinical application of tumor - free tech- nique in operation. Methods In our hospital from 2010 April to 2013 April, 42 patients were included into this study with advanced gastric canc- er. All patients underwent laparoscopic radical gastrectomy for gastric cancer patients. The operation effect and pathological findings were observed and recorded. All these relevant data were summarized and analyzed. Results All patients were successfully performed laparoscopic operation and intraoperative lymph node dissection. No anastomotic fistula, duodena stump fistula, complications such as anastomotic obstruction were detected in all these subjects. A total of 12 groups of lymph node were dissected with an average diameter of （3.8 ± 1.25 ）. The diameter of cancer metas- tasis was （1.3 ± 0.13 ）. Cancer cells were not found in all patients, including near and distal stump tumor. Postoperative follow -up of patients and healthy survival, recurrence, distant metastasis was enhanced compared with preoperation. All these recurrence and metastasis were not found in CT images. All these performance abide strictly by the principles in the operation without tumor resection. Conclusion Laparoscopic gastric cancer can obtain short- term satisfactory operation. However, the results and its long- term effect still need randomized controlled studies, fur- ther multicenter large cases. D2 gastric cancer will have a more broad space for clinical application along with the continuous development of lapa- roscopic techniques, drugs inhibit tumor development, tumor free technology improvement, application of laparoscopy in radical operation.