完全腹腔镜下残胃癌根治术的临床应用及近期疗效

Clinical application and short term effect of total laparoscopic radical gastrectomy for gastric stump cancer

目的:探讨完全腹腔镜下残胃癌根治术的可行性、技术方法及近期临床疗效。方法:回顾分析2013年6月至2015年10月收治的18例残胃癌患者的临床资料,总结手术方式、分析术后恢复情况、近期并发症等。结果:18例患者均成功施行完全腹腔镜下残胃癌根治术,手术时间平均(210.0±20.5)min,术中失血量平均(104.2±23.2)ml,平均清扫淋巴结(28.6±4.0)枚。术后第1天即拔除胃管,排气时间平均(2.3±0.3)d,术后首次进流食时间平均(2.3±0.3)d,术后平均住院(7.2±0.7)d。围手术期无死亡病例术后均未出现腹腔内出血、吻合ロ瘘、残端瘘、吻合ロ狭窄、肠梗阻、反流性食管炎等并发症。结论:完全腹腔镜下残胃癌根治术安全、可行具有术后康复快等优点,食管空肠三角吻合技术应用于腹腔镜残胃癌根治术中安全、可行,可提高生活质量具有良好的近期疗效。

Objective：To investigate the feasibility,technical methods and short term clinical effects of total laparoscopic radical gastrectomy for gastric stump cancer.Methods：Clinical data of 18 patients with gastric stump cancer were retrospectively analyzed from Jun.2013 to Oct.2015.The operation methods were summarized,the postoperative recovery and the recent complications were analyzed.Results：Eighteen cases of totally laparoscopic radical surgery for gastric stump cancer were successful,the average operative time was（210.0±20.5） min,intraoperative blood loss was（104.2±23.2） ml.Number of harvested lymph nodes was（28.6±4.0）.On the first postoperative day gastric tube was removed,exhaust time was（2.3±0.3） d,the first time of liquid intake was（2.3±0.3）d postoperative hospital stay was（7.2±0.7） d.No death occurred in perioperative period,no complications such as abdominal hemorrhage,anastomotic fistula,stump fistula,anastomotic stenosis,intestinal obstruction or reflux esophagitis were not found in any patients.Conclusions：Totally laparoscopic radical gastrectomy for gastric stump cancer is safe feasible,and has advantages of fast recovery.The esophagojejunostomy by delta shaped anastomosis after gastrectomy is safe and feasible.The operation can improve the quality of life of patients and induce satisfactory shorf-term therapeutic effects.