腹腔镜远端胃癌手术的临床应用

目的总结腹腔镜远端胃癌手术的手术经验及术后并发症的防治经验,探讨腹腔镜远端胃癌手术的手术技巧和安全性。方法选取行腹腔镜下远端胃癌手术的患者33例,观察患者手术时间、术中出血、术中邻近器官损伤、术后腹腔引流情况、腹腔感染、吻合口瘘、吻合口狭窄等情况。结果30例患者均顺利完成手术,2例中转开腹手术。1例腹腔镜探查后放弃手术治疗。平均手术时间(180±20)min;术中出血量平均(130±20)mL;术中损伤横结肠1例、损伤脾门分支血管2例、损伤胰大血管1例,均术中腹腔镜下顺利处理;术后腹腔引流管引流量平均(150±20)mL;术后出现腹腔感染2例,经抗感染后痊愈;吻合口瘘1例,经腹腔引流后痊愈;吻合口狭窄1例,转外院经内镜治疗后痊愈;术口感染1例;吻合口出血1例,非手术治疗后痊愈。结论严格把握腹腔镜胃癌手术的手术适应征的同时,术者应具备熟练的腹腔镜操作技巧及开腹手术能力,腹腔镜下远端胃癌手术是安全有效的手术方式。

Objective The aim of this study was to evaluate the surgical safety and discuss the technical skills of laparoscopic distal gastrectomy with lymphadenectomy for the treatment of gastric cancer, based on our initial experience of postoperative complication management. Methods a total of 33 gastric cancer patients underwent laparoscopic surgery for cancer in our hospital. The clinicopathological characteristics and surgical outcomes were retrospectively collected and analized. Results Except for 3 patients, 30 were successfully underwent laparoscopic distal gastrectomy with D 2 lymph node dissection.Two patients experienced open conversion, and one with diagnostic lapasroscopy. The mean operating time was （180±20） min,and the mean intraoperative blood loss was （120±20） mL. There were 4 cases experienced intraoperative adjacent organ injuries, who were all treated successfully by laparoscopy. The mean amount of postoperative abdominal lfuid drainaged was （150±20） mL,while 2 cases of abdominal infection were presented and cured by conservative therapy. There was 1 case of anastomotic leakage, who was cured by the placement of peritoneal drainage. One patient suffered from anastomotic stenosis, cured by endoscopic invertention in other hospital. Anastomotic bleeding was occurred on one patients and cured by conservative treatment. Conclusion Laparoscopic gastrectomy with lymph node dissection might be a technically feasible and safe procedure for the treatment of gastric cancer patient in experienced teams, however, the surgical indication must be adopted carefully.