腹腔镜辅助远端胃根治性切除术的临床体会

目的评价腹腔镜辅助远端胃根治性切除手术在治疗远端胃癌中的应用效果。方法回顾性分析23例进展期胃癌并行腹腔镜辅助下远端胃根治切除术患者,男18例,女5例;胃体癌9例,胃窦癌11例,胃角癌3例。术前通过CT、ECT检查前无肝脏、肺、盆腔、骨等远处转移,除外BorrmannⅣ型。结果术时间平均278.6 min,术中出血平均约188 ml,发现血管变异2例;术后pTNM分期,Ⅱ期11例,Ⅲ_A期12例;平均淋巴结数目21.6个,切缘均阴性,浸润深度T2。肛门排气时间为2~4 d,术后2~3 d下床活动,3~6 d进流质饮食,出院时均恢复饮食。3例肺部感染,经1周保守治疗痊愈出院;无一例切口感染、乳糜腹,静脉血栓形成、吻合口瘘、出血等并发症。患者平均住院日为22.8 d。均临床治愈出院。所有患者均获随访,随访时间11~35个月,3例发生肝转移,2例死于肺感染,无肿瘤复发、Trocar种植及腹膜转移。结论腹腔镜辅助远端胃根治术是治疗远端胃癌安全、有效的方法 。

Objective Evaluation laparoscopic auxiliary distal stomach radical excision of the distal stomach cancer treatment in the application effect.Method 23 patients were retrospectively analyzed of parallel laparoscopic gastric cancer progress aided distal stomach radical resection patients.There were 18 patients were male,female 5 cases and gastric body carcinoma 9 cases.gastric antrum cancer 11 cases,angle of gastric carcinoma 3 cases.There were not distant metastasises about liver,lung,pelvic and bone through preoperative CT.ECT inspection,except Ⅳ Borrmann type.Result The average operation time was 278.S minutes,intraoperative bleeding average about 188 ml.found vascular variation in 2.There were 11 example in Ⅱ stage.Ⅲ A stage for 12 cases of postoperative pTNM staging.The average number of lymph node has 21.6.cutting edge were all negative,infiltration depth less than or equal to T2.The average anal exhaust time were 2d to 4d,postoperative bed activities 2d to 3d.Patients could eat liquid diet in 3- 6 days and recover diet post-discharge.There were 3 cases appearing lung infection,and the patients were discharged a week conservative treatment.No case was incision infection,chylothorax abdomen,deep vein thrombosis,anastomotic fistula and bleeding complications.The average day in hospital patients was 22.8 d.All patients recovered after the treatment.All of the patients have been followed up.follow-up time11-35 months.3 cases had liver metastases.2 case died of lung infection.no tumor recurrence.Trocar planting and peritoneal metastasis.Conclusion Laparoscopic auxiliary distal stomachis is a safe and effective method to cure gastric antrum cancer,angle of gastric carcinoma and body stomach cancer.