基层医院腹腔镜辅助胃癌D2根治术17例疗效评价

目的探讨腹腔镜辅助胃癌D2根治术在基层医院的临床效果。方法回顾性分析2013年9月至2016年8月经腹腔镜辅助胃癌D2根治术治疗的胃癌患者17例，观察术中出血量、手术时间、清扫淋巴结数、术后下地时间、肛门排气时间、开始进食时间、术后拔管时间、术后住院时间及术后并发症等情况。结果全组病例均成功实施了腹腔镜辅助胃癌D2根治术。手术时间170-480min，平均（197±44．9）min；出血量80-500ml，平均（90±101．7）ml；清扫淋巴结16-39枚，平均（21±2．79）枚；术后首次下床活动时间23-116h，平均（28±8．0）h；肛门排气时间44-120h，平均（53±5．7）h；腹腔引流管留置时间4-13d，平均（5．2±2．5）d；术后住院时间7-14d，平均（89±3．1）d，早期胃癌4例（23．5％），进展期胃癌13例（76．5％）；全胃切除术5例（294％），远端胃切除术12例（70．6％），其中毕Ⅱ式吻合3例（17．6％），毕I式吻合9例（52．9％），食管空肠吻合5例（29．4％），联合脏器切除3例（17．6％），术后无严重并发症发生．无围手术期死亡。结论腹腔镜辅助胃癌D2根治术在基层医院应用是安全、可行的。

Objective To evaluate the clinical efficacy of laparoscopy-assisted radical resection with D2 lymph node dissection for gastric carcinoma in primary hospital. Method Retrospective analysis of 17 patients with gastric carcinoma underwent laparoscopy-assisted gastric D2 radical resection from September 2013 to August 2016, in which chnical parameters including blood loss, operation time, lymph nodes number, ambulation time, time for passage of flatus, food intake time, postoperative extubated time, hospital stay and complications were recorded. Result 17 patients were received successful laparoscopy-assisted gastric D2 radical surgery, including 4 early gastric carcinoma patients （23.5%） and 13 advanced gastric carcinoma patients （76.5%） . The operation time was 170 to 480 min, the average was （ 197±44.9 ） rain. the blood loss was 80 to 500 ml, the average （90± 101.7 ） ml, the number of lymph nodes was 16 to 39, the average was （21 ± 2.79 ） ; the ambulation time was 23 to 116 h, the average was （ 28 ± 8.0 ） h, the time for passage of flatus was 44 to 120 h, the average was （ 53 ± 5.7 ） h, postoperative extubated time was 4 to 13 d, the average was （ 5.2± 2.5 ） d, postoperative hospital stay was 7 to 14 d, the average was （ 8.9 ±3.1 ） d. Five cases received total gastrectomy （29.4%） ） , radical distal gastrectomy was performed in 12 cases （ 70.6% ） , and all the cases were divided into BiUroth I group （ 9 cases, 52.9%） ） , Billroth II group （ 3 cases, 17.6% ） and Kouxen-Y group （ 5 cases, 29.4% ） , in which combined devisceration was performed in 3 cases. There was no major postoperative comphcations and no perioperative death occurred. Conclusion Laparoscopy-assisted gastric D2 radical resection is a feasible and safe surgical procedure for patients of gastric carcinoma in primary hospital.