腹腔镜根治术在早期胃癌治疗中应用价值  

Laparoscopic radical gastrectomy for early gastric cancer

作　　者：胡伟国[1] 郑民华[1] 马君俊[1] 陆爱国[1] 孙延军[1] 臧潞[1] 王明亮[1] 李健文[1] 吴云林[2] 朱正纲[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院上海市微创外科临床医学中心外科,上海200025 [2]上海交通大学医学院附属瑞金医院上海市微创外科临床医学中心消化内科,上海200025

出　　处：《中国实用外科杂志》2007年第11期876-878,共3页Chinese Journal of Practical Surgery

摘　　要：目的探讨腹腔镜早期胃癌根治性手术的临床应用价值。方法回顾性分析2004年10月至2007年5月上海交通大学医学院附属瑞金医院31例早期胃癌行腹腔镜辅助胃癌根治术的临床资料,包括手术方式、手术时间、术中失血、术后排气时间、术后住院天数、并发症、术后病理和随访等。结果所有手术均在腹腔镜下完成,其中腹腔镜辅助远端胃切除术28例,近端胃切除术2例,全胃切除术1例。腹腔镜下胃周围淋巴结清扫（D1＋α）16例,胃周围淋巴结＋肝动脉旁淋巴结清扫（D1＋β）2例,扩大淋巴结清扫（D2）13例。手术时间195（90～280）min,术中失血146（40～800）mL,术后排气时间1.8（1～4）d,术后住院天数10.8（7～20）d,1/31例（3.2%）病人出现术后吻合口瘘,经非手术治疗后痊愈。手术上、下切缘距离肿瘤为3.8（1～8）cm和3.5（1.5～7.0）cm,手术清扫淋巴结9.6（2～19）枚。术后随访14（2～32）个月,均无肿瘤复发和远处转移。结论腹腔镜辅助胃癌根治术是治疗早期胃癌安全、可行、微创、有效的方法。Objective To evaluate laparoscopy-assisted radical gastrectomy for early gastric cancer. Methods The clinical data of 31 patients with early gastric cancer underwent laparoscopy-assisted radical gastrectomy from October 2004 to May 2007 were reviewed and analyzed with the surgical procedure, operative time, blood loss, time for passage of flatus, post-operative hospital stay, complications and pathology retrospectively. Results All patients underwent laparoscopyassisted gastrectomy and lymph nodes dissection successfully without conversion to open surgery, including 28 distal gastrectomy,2 proximal gastrectomy and l total gastrectomy. Sixteen patients,2 patients,and 13 patients were performed with D1＋α,D1＋β, and D2 lymph nodes dissection respectively. The mean operative time was 195 （90 -280） min. The blood loss was 146 （40 -800 ） mL. The time for passage of flatus was 1.8 （ 1 -4 ）d and the post-operative hospital stay was 10. 8 （7 -20 ）d. Except one patient （3.2%）with anastomostic leakage, no operative complication occurred. The tumor to normal resection margin was 3. 8 （ 1 - 8 ） cm and 3.5 （ 1.5 - 7.0 ） cm, and average number of dissected lymph node with gastrectomy was 9. 6 （2- 19）. After 14 （2 -32） months follow-up, there was no operative recurrence and metastasis. Conclusion Laparoscopy-assisted radical gastrectomy is the safe, feasible, effective and less invasive surgery for early gastric cancer.

关 键 词：腹腔镜 早期胃癌 

分 类 号：R6[医药卫生—外科学]