腹腔镜手术治疗残胃癌7例分析

Laparoscopic gastrectomy for gastric stump cancer： analysis of 7 cases

目的探讨腹腔镜手术治疗残胃癌的安全性和可行性。方法回顾性分析2008年1月至2015年7月间在浙江省人民医院胃肠胰外科接受腹腔镜手术治疗的7例残胃癌患者的临床和随访资料。结果7例患者中男性5例，女性2例；年龄（62．1±10．7）岁；胃良性病变术后残胃癌4例，距胃首次手术时间6—30年；胃癌术后残胃再发癌3例，距胃首次手术时间11～15年。首次手术行BillrothⅡ术式者6例，Roux—en．Y术式者1例。本次手术分离腹腔粘连及探查腹腔后确定肿瘤位置后，行残胃切除加淋巴清扫术，然后进行食管空肠Roux—en-Y吻合。1例使用圆形吻合器行食管空肠端侧吻合：2例使用内镜直线切割闭合器食管空肠侧侧吻合：4例行手工缝合食管空肠吻合。手术时间（247．1±17．5）min；术中出血量（100．0±30．8）ml；术中均未输血。淋巴结清扫（19．1±4．8）枚。术后肛门排气时间（3．3±1．5）d；进食流质时间（3．7±0．8）d，住院时间（9．4±2．6）d。1例患者术后出现消化道出血，保守治疗后痊愈；无围手术期死亡者。术后7例均获得随访，随访时间截至2016年1月。随访6．38月。1例术后17月死于腹腔转移，1例术后19月死于阿尔茨海默病。存活的5例至今无肿瘤复发或转移。结论腹腔镜手术治疗残胃癌安全可行。

Objective To evaluate the safety and feasibility of laparoscopic gastrectomy for gastric stump cancer. Methods Clinical and follow-up data of 7 patients who underwent laparoscopic gastrectomy for gastric stump cancer in our department from January 2008 to July 2015 were analyzed retrospectively, Results There were 5 male and 2 female patients, with a mean age of （62.1±10.7） years. Initial gastrectomy was performed for gastric cancer in 3 patients and peptic ulceration in 4. The initial surgery was B-Ⅱ gastrojejunostomy in 6 patients and Roux-en-Y gastrojejunostomy in 1. Duration between primary gastrectomy and occurrence of gastric stump cancer was ranged from 6-30 years for peptic ulceration, and from 11-15 years for gastric cancer. During the operation, adhesiolysis and exploration to locate the tumor were performed. Following total remnant gastrectomy and lymphadenectomy, intracorporeal anastomosis was accomplished by Roux-en-Y reconstruction. The methods of intracorporeal esophagojejunostomy were end-to-side approach using a circular stapler in 1 patient, side-to-side approach using an endoscopic linear staple in 2 patients, and hand-sewn technique in 4 patients. The operation time was （247.1 ± 17.5） minutes and the intraoperative blood loss was （100.0 ± 30.8） ml without transfusion. The number of retrieved lymph node was 19.1 ± 4.8. The first flatus time, diet resumption time, postoperative hospital stay were （3.3 ± 1.5） days, （3.7 ± 0.8） days, （9.4± 2.6） days, respectively. One patient experienced gastrointestinal bleeding that was managed conservatively and ultimately cured. Seven patients were followed up till January 2016. After follow-up from 6 to 38 months, 1 patient died of peritoneal metastasis 17 months after surgery, and 1 patient died of Alzheimer＇s disease 19 months after surgery. The other 5 patients were still alive without metastasis or reeurrenee. Conclusion Laparoseopic gastreetomy for gastric stump cancer is feasible and safe.