腹腔镜胃手术的临床应用  

Laparoscopic gastric resection

作　　者：柯重伟[1] 郑成竹[1] 仇明[1] 沈炎明[1] 华积德[1] 

机构地区：[1]第二军医大学长海医院普外科,上海200433

出　　处：《中华外科杂志》2000年第9期680-682,共3页Chinese Journal of Surgery

摘　　要：目的　探讨经腹腔镜胃手术的临床价值。　方法　 1992年 12月至 1999年 1月应用腹腔镜技术治疗胃疾病患者 6 1例。年龄 2 9 0～ 78 0岁 ,平均 5 7 4岁。其中B Ⅱ式胃大部切除术 17例 ,B Ⅰ式胃大部切除术 1例 ,近端胃次全切除术 2例 ,高选择性迷走神经切断术 5例 ,胃造瘘术 3例 ,胃壁良性肿瘤切除术 33例。 5 4例手术完全在腹腔镜下进行 (88 5 % ) ,7例行腹腔镜辅助下胃手术(11 5 % )。　结果　本组患者手术时间 35～ 310min ,平均 (16 4 2± 93 5 )min ;术中出血 5 0～ 5 0 0ml,平均 (2 18 3± 16 6 6 )ml;住院时间 4～ 11d ,平均 (6 8± 2 1)d。 2例早期胃癌行腹腔镜根治术的患者 ,至今存活 4 6年以上 ;2例出现术后并发症 (3 3 % ) ,分别通过再手术和内窥镜治愈。本组 86 %患者于术后48min内恢复胃肠功能 ;4例术后使用止痛剂 ;无手术死亡发生。　结论　虽然 ,腹腔镜胃手术的指征有待进一步总结 ,但只要合理使用 。Objective[WT5”BZ] To modify laparoscopic surgery for gastric diseases. [WT5”HZ]Methods[WT5”BZ] From Decem be 1992 to January 1999, 61 gastric laparoscopic operations were performed in our hospital. The age of the patients ranged from 29 to 78 years (mean 57 4). 17 patients had Billroth II gastrectomy, 1 Billroth I gastrectomy, 2 proximal subtotal gastrectomy, 5 highly selective vagotomy, 3 gastrostomy, and 33 resection of gastric submucosal benign tumor. 54 patients (88.5%) underwent complete laparoscopy, and 7 (11 5%) an assisted one [WT5”HZ]Results[WT5”BZ] The mean operative time was (164 2±93 5) min, the mean estimated blood loss was (218 3±166 6) ml, and the mean hospital stay was (6 8±2 1) days. Flatus was present within 48 hours in 86% of the patients. Two patients had laparoscopic surgery for early gastric cancer, and were followed up for more than 55 months. Postoperative complication were noted in 2 patients, who were cured by reoperation and endoscopy therapy respectively. Only 4 patients required postoperative analgesics. [WT5”HZ]Conclusion[WT5”BZ] Although specific indications need to be defined, laparoscopyic surgery is feasible. But long term follow up should be made to evaluate its efficacy in treatment of gastric cancer. [WT5”HZ]

关 键 词：腹腔镜 胃手术 术式 疗效 

分 类 号：R656.6[医药卫生—外科学]