完全左侧入路腹腔镜根治性全胃切除术的临床疗效分析

Analysis of clinical efficacy of laparoscopic radical total gastectomy via complete left approach

目的:探讨完全左侧入路腹腔镜根治性全胃切除术的安全性和可行性。方法:回顾性分析2016年1月—2017年7月实施完全左侧入路腹腔镜根治性全胃切除术36例进展期胃癌患者的临床资料。结果:36例患者中男20例,女16例;平均年龄(61.7±13.3)岁;胃上部癌19例,胃中部癌17例。36例患者均手术成功,无中转开腹,术中无联合脾脏等脏器切除及相关并发症,术后无严重手术相关并发症。手术时间为(228.6±45.9)min,术中出血量(82.7±25.5)mL。术后病理结果显示,平均淋巴结清扫数目(35.5±6.2)枚,其中淋巴结阳性数目为(3.9±2.1)枚;肿瘤分期为ⅡA期4例(8.3%),IIB期7例(16.7%),ⅢA期10例(33.3%),ⅢB期9例(25.0%),ⅢC期6例(16.7%)。术后2例(5.6%)切口感染,2例(5.6%)炎性肠梗阻,1例(2.8%)发生肺部感染,均经对症保守治疗后痊愈。结论:完全左侧入路腹腔镜根治性全胃切除术是安全的、可行的。

Objective： To investigate the safety and feasibility of laparoscopic radical total gastectomy via complete left approach. Methods： The clinical data of 36 patients with advanced gastric cancer undergoing laparoscopic radical total gastectomy via complete left approach from January 2016 to July 2017 were retrospectively analyzed. Results： Of the 36 patients, 20 cases were males and 16 cases were females, with an average age of （ 61.7± 13.3 ） years; 19 cases had cancer of proximal stomach and 17 cases had cancer of middle third of stomach. Operation was successfully performed in all of the 36 patients who underwent operation; none of the patients required open conversion or combined excision of the spleen and other organs and there was no occurrence ofintraoperative complications or serious postoperative complications. The average operative time was （ 228.6±45.9 ） min, and the average intraoperative blood loss was （ 82.7 ±25.5 ） mL. Postoperative pathological results showed that the average number oflyrnph nodes harvested was 35.5±6.2, with an average positive number of 3.9±2.1; the tumor stages included ⅡAin 1 case （8.3%）, ⅡB in 2 cases （16.7%）, ⅢAin 4 cases （33.3%）,ⅢB in 3 cases （25.0%）, and ⅢC in 2 cases （ 16.7% ）. After operation, wound infection occurred in 2 patients （ 5.6% ）, inflammatory bowel obstruction occurred in 2 patients （5.6%）, and pulmonary infection occurred in 1 case （2.8%）, which were all cured with conservative treatment. Conclusion： Laparoscopic radical total gastectomy via complete left approach is safe and feasible.