腹腔镜辅助胃癌根治术(附48例报告)

Laparoscopic-assisted radical gastrectomy for gastric cancer: with a report of 48 cases

目的：探讨腹腔镜辅助胃癌根治术的安全性与手术疗效。方法：回顾分析48例腹腔镜胃癌根治切除术的临床资料,评价其手术时间、术中出血量、术后住院时间、并发症发生率、中转开腹率及淋巴结清扫数量。结果：3例中转开腹,45例成功完成腹腔镜手术。远端胃切除、全胃切除、近端胃切除手术时间平均（170.5±15.2）min、（220.3±20.1）min、（180.8±53.7）min。术中出血量：（125.6±19.5）ml、（320.2±31.7）ml、（178.4±24.8）ml。淋巴结清扫数量：（23.8±8.2）、（25.7±4.6）、（22.5±9.1）。术后住院时间：（7.5±2.1）d、（8.9±6.4）d、（7.2±3.7）d。术后随访3~24个月,7例复发转移（包括中转开腹2例）,术后发生并发症6例。结论：腹腔镜辅助胃癌根治术是治疗进展期胃癌安全、可行且近期疗效良好的手术方法。随着腹腔镜器械的改进,术者手术经验的积累、操作技术的熟练及对胃癌生物学特性的进一步认识,合理地将腹腔镜同其他内窥镜技术联合起来,腹腔镜胃癌根治术会得到更好地开展与推广,适应证将不断扩展。

Objective： To investigate the safety and efficacy of laparoscopy-assisted radical gastrectomy for gastric cancer. Methods ： The clinical data of 48 patients who underwent laparoscopy-assisted radical gastrectomy for gastric cancer were retrospectively analyzed. Operative time, blood loss, postoperative hospital stay, complications, rate of conversion to open surgery, number of lymph node dissection were evaluated. Results：Three cases were converted to laparotomy, 45 patients successfully underwent laparoscopy-assisted gastrectomy. For the patients who underwent distal gastrectomy, total gastrectomy or proximal gastrectomy, operation time was （170.5 ± 15.2） min, （220.3 ± 20.1 ） min, （ 180.8 ± 53.7 ） min respectively ;intraoperative bleeding was （ 125.6 ± 19.5 ） ml, （ 320.2 ± 31.7） m1,（178.4 ± 24.8） ml respectively ; number of harvested lymph node was （23.8 ± 8.2）,（25.7 ± 4.6）,（22.5 ± 9.1） respectively ; postoperative hospital stay was （7.5 ± 2.1 ） d, （ 8.9 ± 6.4） d, （7.2 ± 3.7 ） d. The postoperative follow-up time was 3 to 24 months ,7 cases of recurrence and metastasis （including 2 cases who were converted to laparotomy） ,6 cases of postoperative com- plications were found. Conclusions ： Laparoscopy-assisted gastrectomy is both safe and feasible for advanced gastric cancer with mini-in- vasion and quick postoperative recovery. Along with the improvement of laparoscopic instruments, accumulation of operative experi- ences, proficiency of operation, further recognization of biological characteristics of gastric cancer, reasonable combination of laparoscopy and other endoscopic techniques can better launch and popularize laparoscopie radical gastrectomy for stomach cancer, and constantly enlarge indications.