腹腔镜辅助胃癌根治术治疗早期和进展期胃癌的临床研究

Application of laparoscopy-assisted radical gastrectomy for early and advanced gastric cancer

目的：探讨腹腔镜辅助胃癌根治术治疗早期和进展期胃癌的临床价值。方法：回顾2004年2月至2010年12月上海交通大学医学院附属瑞金医院外科收治的209例行腹腔镜辅助胃癌根治术胃癌病人的临床和手术资料。结果：腹腔镜辅助远端胃切除术170例,近端胃切除术9例,全胃切除术30例;腹腔镜下D1＋α淋巴结清扫37例,D1＋β淋巴结清扫32例,D2淋巴结清扫140例。手术时间为（218.3±54.4）min,术中出血量为（201.2±188.1）mL。手术近、远端切缘距离为（4.5±2.0）cm和（4.6±2.1）cm,淋巴结清扫数目为（19.1±9.7）枚。早期胃癌和进展期胃癌淋巴结获取数分别为（16.4±8.4）枚和（21.9±10.2）枚。25例（11.9%）病人发生吻合口漏、腹腔内出血、小肠梗阻等并发症。根据术后病理分期：ⅠA期病人100例（47.8%）,ⅠB期病人21例（10.0%）,ⅡA期病人8例（3.8%）,ⅡB期病人31例（14.8%）,ⅢA期病人13例（6.2%）,ⅢB期病人18例（8.7%）,ⅢC期病人18例（8.7%）,中位随访时间31（2-60）个月,死亡率15.8%（33/209）,肿瘤复发率16.3%（34/209）,病人5年总体生存率80.9%,5年无病生存率79.6%。结论：腹腔镜辅助胃癌根治术治疗进展期胃癌,与早期胃癌一样安全可行,具有创伤小、术后恢复快等优点,能达到肿瘤根治目的。

Objective： To evaluate laparoscopy-assisted radical gastrectomy for eady and advanced gastric cancer. Methods Two hundred and ten consecutive patients from February 2004 to December 2010 with laparoscopy-assisted gastrectomy for gastric cancer at Department of Surgery Shanghai Ruijin Hospital were reviewed. Results Including 170 laparoseopy-assisted distal gastrectomy （LADG）, 9 laparoscopy-assisted proximal gastrectomy （LAPG）, and 30 laparoscopy- assisted total gastrectomy （LATG） were performed successfully. Whereas the lymphadectomy of D1＋α, D1＋β, and D2 were 37, 32, and 140, respectively. The operative time of laparoscopy-assised gastrectomy was（218.3±54.4） min, the blood loss was （201.2±188.1） mL.The lengths of proximal and distal resection margin were （4.5±2.0） cm and （4.6±2.1） cm, respectively. The number of the lymph nodes dissected was （19.1±9.7）. The number of lymph node harvest for early gastric cancer and advanced gastric cancer is （16.4±8.4）, （21.9±10.2）,respectively. The post-operative complications including anastomotic leakage,intra-abdominal bleeding, intestinal obstruction occurred in 25 patients （11.9%）. According to the pathologic results, 100 patients were stage Ⅰ A （47.8%）, 21 were stage ⅠB （10.0%）, 8 were stage ⅡA （3.8%）, 31 were stage ⅡB （14.8%）, 13 were stage ⅢA （6.2%）, 18 were stage ⅢB （8.7%）, 18 were stage ⅢC （8.7%）. The median follow- up period was 31 （2±60） months. The mortality is 15.8% （33/209）and the rate of recurrence is 16.3% （34/209）. The overall 5-year survival rate was 80.9%, and the disease-free 5-year survival rate was 79.6%. Corldusions Laparoscopyassisted radical gastreetomy （LAG） for gastric cancer is safe, feasible, minimally invasive and quick recovery. It can achieve the radical resection of the tumor. But randomized controlled trials with large numbers of patients are needed to affirm the validity of the previous results.