摘要
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.
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2016年第5期553-556,共4页
Chinese Journal of Gastrointestinal Surgery
基金
浙江省医药卫生平台重点资助计划(2015ZDA019)
关键词
残胃癌
胃切除术
腹腔镜
安全性
可行性
Gastric stump cancer
Gastrectomy
Laparoscopy
Safety
Feasibility