早期胃癌ESD治疗后腹腔镜补救手术3例并文献复习

Rescue laparoscopic gastrectomy after ESD for early gastric cancer:report of 3 cases and literature review

目的 探讨早期胃癌患者行内镜黏膜下剥离术（ESD）后未达治愈标准的补救方式的选择及行腹腔镜补救手术的安全性和可行性.方法 收集3例早期胃癌ESD治疗后未达治愈标准再行腹腔镜补救手术患者的病例资料,分析其临床病理特征及补救手术指征,并对手术效果进行评价.结果 3例行腹腔镜补救根治性手术的早期胃癌患者ESD治疗均整块切除,术后病理示3例患者的病变黏膜下浸润均超过500μm,其中垂直切缘阳性患者1例,有静脉浸润患者1例,病变直径大于3 cm的患者2例;3例患者行腹腔镜补救手术均无中转开腹,术后均未发现有癌残留及淋巴结转移;手术时间111-151 min,术中出血量50-100 ml,无术中输血.术后排气时间为3-5 d,拔除胃管时间为4-6 d,拔除引流管时间为6-7 d,术后住院天数为8-13 d;3例患者均无手术相关并发症.结论 腹腔镜补救根治性手术是非治愈性ESD后一种安全有效的补救方式.

Objective To examine appropriate rescue strategy for patients who underwent noncurative endoscopic submucosal dissection （ESD） for early gastric cancer and the safety and feasibility of laparoscopic rescue management. Method Three patients who underwent rescue laparoscopic gastrectomy after noncurative ESD for early gastric cancer were retrospectively analyzed, of which the clinicopathological characteristics, surgery indexes and curative effect were evaluated. Result All the 3 patients had en bloc resection in revisional laparoscopic surgery, while postoperative patholo-gy showed that, all the 3 cases had submucosal invasion＆gt;500μm, in which there was 1 with positive vertical margin, 1 with vascular invasion, and 2 had lesion diameter＆gt;3 cm, and no salvage open surgery was implemented during the lapa-roscopic procedure;Neither residual cancer nor lymph node metastasis was found in these patients;For those patients, the operative time was 111-151 min, blood loss was 50-100 ml, and no transfusion was needed;time to first flatus was 3-5 d, time to extubation of gastric tube was 4-6 d, time to extubation of drainage tube was 6-7 d, and the hospital stay after sur-gery was 8-13 d; No intraoperative and postoperative complications were observed. Conclusion Rescue laparoscopic gastrectomy is a safe and feasible salvage procedure in patients with noncurative ESD.