完全腹腔镜保留贲门胃癌根治术的临床应用  

Clinical application of complete laparoscopic gastrectomy with function preservation of cardia in gastric carcinoma

作　　者：王元宇[1] 孟思嘉 金巍巍[1] 鲁超[1] 朱启聪 周育成[1] 牟一平[1] Wang Yuanyu;Meng Sijia;Jin Weiwei;Lu Chao;Zhu Qicong;Zhou Yucheng;Mou Yiping(Department of General Surgery,Cancer Center,Division of Gastrointestinal and Pancreatic Surgery,Zhejiang Provincial People′s Hospital,Affiliated People′s Hospital,Hangzhou Medical College,China and Key Laboratory of Gastroenterology of Zhejiang Province,Hangzhou 310014,China)

机构地区：[1]浙江省人民医院(杭州医学院附属人民医院)普通外科(胃肠胰外科)浙江省人民医院(杭州医学院附属人民医院)肿瘤中心浙江省胃肠病重点实验室,杭州310014

出　　处：《中华医学杂志》2022年第26期2033-2036,共4页National Medical Journal of China

基　　金：国家卫生健康委科学研究基金-浙江省卫生健康重大科技计划(WKJ-ZJ-2201);浙江省科技厅“领雁”重大社会公益项目(2022C03099)。

摘　　要：为了探讨完全腹腔镜保留贲门胃癌根治术的可行性和治疗效果。回顾性收集2020年11月至2021年12月在浙江省人民医院行完全腹腔镜保留贲门胃癌根治术10例患者的临床资料。男7例,女3例;年龄(66.1±12.9)岁(38~86岁)。10例患者均成功实施腹腔镜保留贲门胃癌根治术,无中转开腹,消化道重建时间(24.8±3.3)min(20~30 min),术中出血量(35±24)ml(20~100 ml)。术后排气时间(2.5±0.9)d(2~3 d),术后进食流质饮食时间(2.25±0.87)d(2~3 d),术后住院时间(9.5±2.1)d(6~13 d)。术后未发生出血、吻合口瘘或吻合口狭窄等严重手术相关并发症。术后病理显示,切除标本近远端切缘均阴性。患者术后随访2~15个月,随访期间无死亡或肿瘤复发转移病例。术后无反流症状。与全胃切除和近端胃切除相比,保留贲门功能胃癌根治术理论上能降低反流性食管炎发生率。采用手工缝合法进行消化道重建,可以减少2~3个吻合器枪钉的应用,降低了手术材料费。与胃次全切除术相比,腹腔镜保留贲门胃癌根治术淋巴结清扫更彻底,胃残留组织很少、血供更好,降低了反流性食管炎的发生率。To investigate the feasibility and safety of total laparoscopic cardia function preserving gastrectomy for gastric carcinoma.Clinical data of 10 patients undergoing total laparoscopic cardia function preserving gastrectomy for gastric carcinoma from November 2020 to December 2021 were retrospectively collected.There were 7 males and 3 females.The mean age was(66.1±12.9)years(ranged from 38 to 86 years).All of the 10 patients were successfully performed total laparoscopic cardia function preserving gastrectomy without conversion to laparotomy.The time of digestive tract reconstruction was(24.8±3.3)min(20-30 min),and the intraoperative blood loss was(35±24)ml(20-100 ml).The time of postoperative exhaust was(2.5±0.9)days(2-3 d),the time of postoperative liquid diet was(2.25±0.87)days(2-3 d),postoperative hospital stay was(9.5±2.1)days(6-13 d).No surgical complications such as bleeding,anastomotic fistula or anastomotic stenosis occurred.Postoperative pathology showed that the proximal and distal margins of resected specimens were negative.Patients were followed up for 2 to 15 months,respectively.No death or tumor recurrence and metastasis occurred during the follow-up period.There were no symptoms of reflux after operation.Compared with total gastrectomy and proximal gastrectomy,total laparoscopic cardia function preserving gastrectomy can theoretically reduce the incidence of reflux esophagitis.We used manual suture method for digestive tract reconstruction,which can reduce the application of 2-3 stapling studs and reduce the cost of surgical materials.Compared with subtotal gastrectomy,total laparoscopic cardia function preserving gastrectomy has the advantages of more thorough lymph node dissection,with little residual gastric tissue;therefore,the blood supply is relatively better.The incidence of reflux esophagitis of total laparoscopic cardia function preserving gastrectomy for gastric cancer may was lower than total gastrectomy.

关 键 词：胃肿瘤 保留贲门 腹腔镜 功能保留 

分 类 号：R735.2[医药卫生—肿瘤]