完全腹腔镜根治性全胃切除术中淋巴结清扫和消化道重建应用总结

Summary of experience in the application of lymph node dissection and digestive tract reconstruction in total laparoscopic radical gastrectomy

目的评价完全腹腔镜根治性全胃切除术(totally laparoscopic total gastrectomy,TLTG)在胃上部癌外科治疗中的应用价值。方法回顾性分析浙江大学医学院附属杭州市第一人民医院自2018年1月至2019年6月因胃上部癌实施TLTG的81例患者资料。结果81例患者均顺利完成完全腹腔镜下的TLTG和食管空肠顺蠕动侧侧吻合,无中转开腹病例,平均手术时间(211±22.4)min,平均术中出血量(78±27.2)ml;平均清扫淋巴结(26.3±3.8)枚,总淋巴结阳性病例率为29.6%(24/81),胰腺上区(第7/8/9组淋巴结)阳性病例率为21.0%(17/81),其中37例行脾门淋巴结清扫,阳性病例率为8.1%(3/37);平均术后排气时间(2.3±0.8)d,平均术后住院时间(9.1±3.2)d。其中1例患者术后出现吻合口瘘,经双套管冲洗保守治疗14 d后愈合,4例患者术后出现食管空肠吻合口轻度狭窄,保守治疗后均好转,其余患者未见并发症。结论TLTG治疗胃上部癌中是安全、可行的。

Objective To evaluate the safety and feasibility of totally laparoscopic total gastrectomy(TLTG)in the radical surgery of proximal stomach cancer.Methods Data of 81 patients undergoing TLTG surgery for proximal gastric cancer from Jan.2018 to Jun.2019 in Hangzhou First People′s Hospital Affiliated to Medical College of Zhejiang University were retrospectively analyzed.Results 81 patients completed the TLTG,and no cases were transferred to laparotomy.The average operation time was(211±22.4)min,the average intraoperative blood loss was(78±27.2)ml,the average lymph node dissection was(26.3±3.8),the total positive lymph node rate was 29.6%(24/81),and the splenic hilar positive lymph node rate was 8.1%(3/37),the superior pancreatic region(No.7/8/9 lymph node)positive lymph node rate was 21.0%(17/81),the average postoperative exhaust time was(2.3±0.8)d,and the average postoperative hospital stay was(9.1±3.2)d.One patient developed anastomotic fistula after operation,which healed after conservative treatment with double cannula irrigation;4 patients developed esophagojejunal anastomotic stenosis after operation,which improved after conservative treatment,and no complications were observed in the rest patients.Conclusions TLTG is safe and feasible in radical surgery for proximal gastric cancer.