完全腹腔镜胃癌根治术的临床应用  

Totally laparoscopic gastrectomy for gastric cancer

作　　者：徐晓武[1] 牟一平[1] 严加费[1] 严焕军[1] 许斌[1] 陈其龙[1] 王松彪[1] 周育成[1] 

机构地区：[1]浙江大学医学院附属邵逸夫医院普外科,杭州310016

出　　处：《中华医学杂志》2010年第6期386-389,共4页National Medical Journal of China

基　　金：浙江省教育厅科研项目（Y200803722）

摘　　要：目的评价完全腹腔镜胃癌根治术（TLG）的可行性和临床疗效。方法对2007年3月至2009年4月在浙江大学医学院附属邵逸夫医院进行TLG的37例患者的临床资料进行回顾性分析。37例中男23例，女14例；年龄44～79岁，平均62岁。术前影像学检查除外远处转移、周围脏器侵犯、主要血管受累及腹膜后多发淋巴结转移。结果37例均顺利完成TLG，无一例中转开腹手术或腹腔镜辅助手术。远端胃大部切除29例，全部采用毕Ⅱ式胃肠吻合；全胃切除8例，其中食管空肠端侧吻合5例，食管空肠侧侧吻合3例。19例辅以术中胃镜定位。手术时间210～355min，平均（284±43）min。术中出血80～450ml，平均（175±62）ml。清扫淋巴结18～55枚，平均（31±9）枚。术后肺部感染1例，对症治疗后痊愈；短期胃排空障碍1例，胃肠减压治疗6d后痊愈。无围手术期死亡。术后住院时间6—14d，平均（9±2）d。术后随访2～25个月，未见复发。结论对于有丰富腹腔镜手术经验的术者，TLG是安全可行的。TLG近期疗效良好，而且更符合微创手术理念和肿瘤手术的无瘤操作原则。Objective To evaluate the feasibility and clinical efficacy of totally laparoscopic gastrectomy （TLG） for gastric cancer. Methods The investigators retrospectively analyzed 37 cases undergoing TLG for gastric cancer from March 2007 to April 2009 at Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University. Results All 37 eases underwent successful TLG. There was neither transfer to open nor laparoscopic assisted surgery. Twenty-nine cases underwent distal gastrectomy with Billroth Ⅱ reconstruction, 8 cases total gastrectomy with Roux-en-Y reconstruction, including 5 cases with end-to-side esophageal jejunostomy and 3 cases with side-to-side esophageal jejunostomy. Nineteen cases assisted by intraoperative gastroscopy for tumor locating. The operation duration was 210 -355 min [ mean （284 ± 43 ） min]. The blood loss was 80 -450 ml [mean （175 ±62） ml]. The number of dissected lymph nodes was 18 -55 [ mean （31 ± 9）]. Two cases had post-operative complications, with 1 case of pulmonary infection recovering well after symptomatic treatment and 1 case of temporary delayed gastric emptying recovering well after gastrointestinal decompression for 6 days. No mortality was reported. The hospital stay was 6 - 14 d [mean （9 ±2） d]. There was no recurrence during the follow-up period of 2 -25 months. Conclusions For surgeons with rich experiences of laparoseopie surgery, TLG for gastric cancer is both safe and feasible. The short-term efficacy of TLG is satisfactory. Furthermore, TLG conforms more to the concept of minimally invasive surgery and the principle of tumor-free technique.

关 键 词：腹腔镜 胃切除术 胃肿瘤 

分 类 号：R735.2[医药卫生—肿瘤] R713.42[医药卫生—临床医学]