腹腔镜辅助下胃癌根治术21例报告  

Laparoscopic-assisted Radical Gastrectomy:Report of 21 Cases

作　　者：田夫[1] 邓清[1] 胡小苗[1] 蒋雪峰[1] 邓世红[1] 李明忠[1] 岳信[1] 

机构地区：[1]荆州市第一人民医院胃肠外科,荆州434000

出　　处：《中国微创外科杂志》2012年第3期217-219,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨腹腔镜辅助下胃癌根治术的临床效果。方法 2009年2月～2010年10月施行21例腹腔镜辅助下胃癌根治术,其中根治性远端胃切除14例,根治性近端胃切除4例,根治性全胃切除2例。结果腹腔镜辅助下胃癌根治术成功20例,1例因脾脏上极受侵犯,与膈肌粘连严重中转开腹。14例根治性远端胃切除手术时间235～280 min,平均260min;出血量90～150 ml,平均115 ml。4例根治性近端胃切除手术时间260～310 min,平均290 min;出血量110～190 ml,平均160 ml。根治性全胃切除2例,手术时间分别为305、340 min,出血量分别为180、210 ml。清扫淋巴结11～23枚,平均15枚。术后肛门排气时间29～78 h,平均51 h;术后3～5 d开始流质饮食。术后发生并发症2例:胃排空障碍1例,肺部感染1例,经保守治疗后痊愈。16例随访1～11个月,平均5个月,1例术后4个月出现腹腔内转移,未发生切口和穿刺口种植。结论腹腔镜辅助下行胃癌根治术方法可行,效果好,具有视野清晰、创伤小、出血少、恢复快等优点。Objective To explore the efficacy of laparoscopic-assisted radical gastrectomy. Methods Totally 21 patients with gastric cancers received laparoscopic-assisted radical gastrectomy,including radical distal gastrectomy in 14 cases,radical proximal gastrectomy in 4 cases,and radical total gastrectomy in 2 cases,in our hospital from February 2009 to October 2010.Results The procedure was completed successfully in 20 of the patients,and the other one was converted to an open procedure because the cancer had invaded the upper pole of the spleen,which was adhered to the diaphragm extensively.No patient died of the surgery.The mean operation time and blood loss of the 14 patients who received radical distal gastrectomy were 260 min（235-280 min） and 115 ml（90-150 ml）,and those of the 4 cases of radical proximal gastrectomy were 290 min（260-310 min） and 160 ml（110-190 ml）.In the two cases of radical total gastrectomy,the operation time was 305 and 340 min,and blood loss was 180 and 210 ml,respectively.A mean of 15 lymph nodes were removed（11-23） during the procedure.The postoperative recovery time of gastrointestinal function was 29-78 h（mean,51 h）,and the patients began fluid intake in 3 to 5 days after the operation.Two patients developed postoperative complications including one case of delayed gastric emptying and one case of pulmonary infection,both the patients were cured by conservative surgery.Follow-up was achieved in 16 of the cases for a mean of 5 months（1-11 months）：one of the cases showed abdominal metastasis in 4 months after the operation;no incisional or puncture-site metastasis occurred.Conclusion Laparoscopic-assisted radical gastrectomy is a feasible,safe,and minimally invasive procedure with a clear surgical field,less blood loss,and quick recovery.

关 键 词：腹腔镜辅助 胃癌 根治性胃切除 

分 类 号：R735.2[医药卫生—肿瘤]