3D腹腔镜胃癌根治术的临床疗效

Clinical efficacy of three-dimensional laparoscopic radical gastrectomy in patients with gastric cancer

目的探讨3D腹腔镜胃癌根治术的可行性和临床疗效。方法回顾性分析2013年12月至2014年11月上海交通大学医学院附属瑞金医院收治的21例行3D腹腔镜胃癌根治术患者的临床资料。3D腹腔镜胃癌根治术手术适应证及手术方法与2D腹腔镜相同。采用门诊及电话方式进行随访，随访时间截至2015年1月。结果21例患者均成功完成3D腹腔镜胃癌根治术，其中8例行完全3D腹腔镜胃癌根治术（1例同时行胆囊切除术），13例行3D腹腔镜辅助胃癌根治术（1例同时行胆囊切除术、1例同时行乙状结肠癌根治术），无中转开腹，无术中并发症发生，无围术期死亡患者。21例患者平均手术时间为240min（180～300min），平均术中出血量为100mL（10～180mL），平均淋巴结清扫数目为29枚（10—48枚），平均术后肛门排气时间为3d（1～4d），平均术后住院时间为9d（7～15d）。21例患者中，1例患者术后发生肺部感染，予对症保守治疗后好转；其余患者无并发症发生。所有标本为R。切除，镜下切缘阴性。21例患者均获得随访，随访时间为2～13个月，中位随访时间为7个月。随访期间，无手术相关并发症发生，无肿瘤复发，无患者死亡。结论3D腹腔镜胃癌根治术安全可行，近期疗效可靠。

Objective To investigate the feasibility and clinical efficacy of three-dimensional （3D） laparo-scopic radical gastrectomy in patients with gastric cancer. Methods The clinical data of 21 patients who under- went 3D laparoscopic radical gastrectomy for gastric cancer at the Ruijin Hospital from December 2013 to November 2014 were retrospectively analyzed. The surgical indications and method of 3D laparoscopic radical gastrectomy were similar to that of two-dimensional laparoscopic radical gastrectomy. All the patients were followed up via out- patient examination and telephone interview till January 2015. Results All the 21 patients underwent successfully laparoscopic surgery without conversion to open surgery, intraoperative complications and perioperative death. Eight patients underwent 3D laparoscopic radical gastrectomy （1 received concomitant cholecystectomy） and 13 underwent 3D laparoscopic-assisted radical gastrectomy （ 1 received concomitant cholecystectomy and 1 received concomitant radical resection of sigmoid colon）. The mean operation time, mean volume of intraoperative blood loss, mean number of lymph node dissection, mean time to anal exsufflation and mean duration of hospital stay were 240 minutes （range, 180-300 minutes）, 100 mL （range, 10-180 mL）,29 （range, 10-48）, 3 days （range, 1-4 days） and 9 days （range, 7-15 days）, respectively. Among the 21 patients, 1 patient was compli- cated with pulmonary infection and cured by conservative treatment, and no occurrence of complication was detec- ted in the other patients. R0 tumor resections in all the patients were done and the tumor resection margins were negative. Twenty-one patients were followed up for 2-13 months with a median time of 7 months and without occurrence of surgery-related complications, tumor recurrenee and death during the follow-up. Conclusion Three-dimensional laparoseopie radical gastreetomy is safe and feasible for the treatment of gastric cancer with the advantages of favorable short-term outcomes.