全腹腔镜下胃癌根治术11例治疗体会

The experience of totally laparoscopic complete gastrectomy for 11 cases

目的：总结全腹腔镜下胃癌切除及重建的临床经验,初步确定其可行性、安全性及实用性。方法：回顾分析2015年4月至2016年2月11例全腹腔镜下胃癌切除及重建患者的临床资料,观察分析手术时间、术中出血量、术后排气时间、术后进食时间、术后吻合口漏情况、术后住院时间、住院费用及淋巴结获取数量。结果：11例患者均顺利完成手术,手术时间平均（193.82±34.88）min,术中出血量平均（34.10±18.41）ml,术后排气时间平均（2.00±0.63）d,术后平均住院（3.36±0.50）d,淋巴结清扫数量平均（27.45±4.95）枚,切缘均为阴性。患者术后随访4~8周,1例近端胃患者术后并发食管-残胃吻合口漏,经保守治疗后治愈出院,其余患者均恢复良好,无肿瘤复发及死亡病例。结论：虽然镜下重建难度较大,但全腹腔镜下行胃癌切除及重建是安全、可行的,值得应用推广。

Objective： To summarize the clinical experience of the totally laparoscopic gastrectomy for gastric cancer,in order to confirm its feasibility,safety and practicability. Methods： A retrospective analysis was made on the clinical data of 11 patients who underwent the laparoscopic gastrectomy for gastric cancer and reconstruction from Apr. 2015 to Feb. 2016. The operation time,intraoperative bleeding,time of postoperative flatus,eating time,anastomotic leakage,hospital stay,hospitalization cost and harvested lymph nodes were observed and analyzed. Results： All surgeries were successful with negative resection margin. The average operating time was（ 193. 82 ± 34. 88） min,intraoperative blood loss was（ 34. 10 ± 18. 41） ml. Postoperative flatus time was（ 2. 00 ± 0. 63） d,hospital stay was（ 3. 36 ± 0. 50） d. The hospitalization cost was（ 3 918. 09 ± 422. 55） yuan. The harvested lymph node was（ 27. 45 ± 4. 95）.Patients were followed up for 4-8 weeks,1 patient suffered from esophagus-stomach anastomotic leakage and recovered after conservative treatment. The other patients recovered well. There were no tumor recurrence or death. Conclusions： Although laparoscopic reconstruction is difficult,the totally laparoscopic resection of gastric cancer and reconstruction is safe and feasible,it is worth application and promotion.