手助腹腔镜胃癌D2根治术的团队配合

Teamwork Cooperation in Hand-assisted Laparoscopic D2 Radical Gastrectomy

目的：探讨手助腹腔镜胃癌D2根治术的团队配合技巧及重要性。方法对我中心2010年12月～2013年6月180例手助腹腔镜胃癌D2根治术的临床资料进行回顾性总结。术者及助手相对固定，只需术者及扶镜手两人相互配合，就能完成肿瘤的根治性切除及淋巴结清扫。结果180例均在手助腹腔镜下完成手术，全胃切除术84例，远端胃切除术81例，近端胃切除术15例。手术切口长度（6．9±0．5）cm；术中出血量（226．1±127．0）ml；手术时间（172．2±34．1）min；病检获淋巴结数（17．3±5．0）枚；术后住院时间（9．3±2．0） d。围手术期死亡1例，手术残端癌残留2例。手术相关并发症率6％（11／180）。术后随访1～24个月，失访12例（失访率7％），同时性肝转移4例，异时性淋巴结转移2例，局部复发1例，未发生切口和穿刺口种植。结论良好的团队配合是保证手助腹腔镜胃癌D2根治术的必备条件，对肿瘤的根治程度、手术时间及术后并发症的发生起着至关重要的作用。

Objective To discuss the importance of teamwork coorperation in hand-assisted laparoscopic D2 radical gastrectomy. Methods Clinical materials of 180 patients with gastric cancer undergoing hand-assisted laparoscopic D2 radical gastrectomy from December 2010 to June 2013 were summarized retrospectively.The lymph nodes dissection and radical tumor excision were performed by two persons of cooperation that the operator surgeon worked with camera assistant in a relatively fixed mode in the operation. Results The hand-assisted laparoscopic D2 radical gastrectomy was accomplished in all the patients.Among the 180 patients, gastrectomy was performed in 84 cases, distal gastrectomy in 81 cases, and proximal gastrectomy in 15 cases.The average length of incision was （6.9 ±0.5） cm, the blood loss was （226.1 ±127.0） ml, the operative time was （172.2 ±34.1） min, the number of lymph nodes obtained for pathological examination was （17.3 ±5.0）, and the length of postoperative hospital stay was （9.3 ±2.0） d, respectively.The perioperative death occurred in 1 case, and tumor tissue in the stump was found in 2 cases.The incidence of postoperative complications was 6% （ 11/180 ） .During a postoperative follow-up ranged from one month to 24 months, simultaneous liver metastases were found in 4 cases, heterochronic lymph node metastasis occurred in 2 cases, and local recurrence developed in 1 case, respectively.Neither puncture nor port site implantation occurred during the follow-up.Twelve patients （7%） were lost to follow-up. Conclusions Good teamwork is the necessary condition for the successful accomplishment of hand-assisted laparoscopic D2 radical gastrectomy.It plays a crucial role in guaranteeing the radical effect, shortening operation time and reducing occurrence of postoperative complications.