应用无瘤技术行腹腔镜下胃癌D_2根治术153例

Application of Tumor-free Technology for D_2 Radical Gastrectomy under Laparoscopes in Treatment of 153 Patients with Gastric Cancer

目的 探讨腹腔镜下胃癌D2根治术中应用无瘤技术的可行性及有效性.方法 对我院2010年12月-2012年12月收治进展期胃癌153例行腹腔镜下胃癌D2根治术,观察临床效果.结果 153例成功行胃癌D2根治术,其中远侧胃BillrothⅡ式手术94例,手术时间（172.2 ±39.6）min,术中出血（54.4±12.1） ml;近侧胃次全切食管残胃吻合术37例,手术时间（212.7±21.8） min,术中出血（83.2±37.4） ml;全胃Roux-Y食管空肠吻合术22例,手术时间（236.6±32.8） min,术中出血（115.7±20.4） ml.术后随访6- 28个月,均未见Trocar孔及切口肿瘤种植转移.结论 无瘤技术应用于腹腔镜下胃癌D2根治术可有效减少患者术后腹腔、Trocar孔、切口种植瘤的发生,疗效满意,安全可行.

Objective To explore the feasibility and effectiveness of using the tumor-free technology for D2 radi- cal gastrectomy under Laparoscopes in treatment of gastric cancer. Methods A total of 153 patients with advanced gastric cancer underwent D2 radical gastrectomy under Laparoscope by using the tumor-free technology during December 2010 and December 2012, and the clinical effects were observed. Results All operations in 153 patients were successful, in- cluding 94 patients who underwent distal gastric Billroth Ⅱ type with （172.2 ± 39.6）min of operation time and （54.4 ± 12. 1 ）ml of intraoperative blood loss; 37 patients underwent proximal gastric gastrectomy and anastomosis for esophagus with gastric remnant, the operation time was （212.7±21.8）min, and average blood loss was （83.2± 37.4）ml; 22 pa- tients underwent Roux-Y type esophagojejunostomy, the average operation time was （236.6± 32.8） min, and average blood loss was （ 115.7 ± 20.4） ml. During postoperative 6 - 28 months follow-up, there was no tumorous implantation or metastasis in Trocar hole and incision. Conclusion Tumor-free technology applied for D2 radical gastrectomy under Lap- aroscopes in treatment of gastric cancer can effectively reduce incidence rates of postoperative implantation tumors in ab- dominal cavity, Trocar hole and incision, and it is safe and feasible with satisfactory curative effect.