囊外左侧入路在中上部胃后壁癌腹腔镜根治性全胃切除联合网膜囊切除术的临床疗效分析

Clinical effect of advanced gastric cancer underwent totally laparoscopic radical total gastrectomy with bursestomy: a left outside bursa omentalis approach

目的探讨囊外左侧入路在中上部胃后壁癌腹腔镜根治性全胃切除联合网膜囊切除术的安全性和可行性。方法回顾性分析2016年1月至2016年7月针对中上部胃后壁c T3或c T4胃癌患者实施囊外左侧入路腹腔镜根治性全胃切除联合网膜囊切除术12例,分析患者基线资料、术中、术后结果以及术后随访情况。结果 12例患者均顺利完成根治性全胃切除联合完整网膜囊切除术,无中转开腹,术中无脏器损伤及出血等并发症,术后无腹腔出血、胰瘘等严重并发症。手术时间为(295.2±47.9)分钟,术中失血量为(105.7±39.4)ml,术后病理结果显示,平均淋巴结清扫数目为(32.1±9.4)枚,其中淋巴结阳性数目为(4.2±2.3)枚,网膜囊淋巴结数目为(3.2±1.2)枚,未见阳性淋巴结,肿瘤分期:ⅡA期1例(8.3%),ⅡB期2例(16.7%),ⅢA期4例(33.3),ⅢB期3例(25.0%),ⅢC期2例(16.7%)。术后1例(8.3%)切口感染和1例(8.3%)炎性肠梗阻,均经保守治疗后痊愈出院。术后随访13~22月,中位随访时间17月,1例发生术后腹腔、腹膜转移,其余11例均无瘤生存,无一例出现吻合口复发。结论囊外左侧入路在中上部胃后壁癌腹腔镜根治性全胃切除联合网膜囊切除术是安全、可行的,为实现腹腔镜下完整网膜囊切除提供新思路。

Objective Laparoscopic radical total gastrectomy with bursectomy for advanced gastric cancer underwent is widely performed, but laparoscopic complete bursectomy is technically challenging. We aim to explore the safety and feasibility of totally laparoscopic radical total gastrectomy using a left outside bursa omentalis approach to accomplish complete bursectomy. Methods From January 2016 to July 2016,12 consecutive patients with advanced gastric cancer underwent totally laparoscopic radical total gastroectomy using a left outside bursa omentalis approach. The baseline characteristics, intra-operative and postoperative outcomes were prospective collected and reviewed retrospectively. Results 7 males and 5 females were included and all operations were completed without death. No intra-operative complication was recorded. The mean operative time was 295.2 ±47.9 min with a mean estimated blood loss of 105.7 ±39.4 ml. The mean time of first flatus was 47.2±17.3 hours and liquid oral intake was 73.6 ±22.1 hours. The postoperative hospital stay was 9.5 ±3.2 day. The mean harvested number of lymph nodes was 32.1 ±9.4 among which 4.2 ±2.3 was positive. There were 3.2 ±1.2 lymph nodes in bursa omentalis, but no positive was recorded. One patient（8.3%） appeared inflammatory bowel obstruction and one incision infection（8.3%）. They were all cured with conservative measure. All 12 patients were followed up for 13 ~22 months, with a median time of 17 months. One case had peritoneal cavity and peritoneal metastasis after operation. No anastomotic recurrence occurred, and the remaining 11 cases had no tumor survival. Conclusions Totally laparoscopic radical total gastroectomy with bursectomy using a left outside bursa omentalis approach is safe and technically feasible. It can accomplish complete bursectomy, with further studies required.