腹腔镜下近端胃癌D2根治术的应用探讨

目的探讨腹腔镜下近端胃癌D2根治术的可行性。方法2009年3—6月对5例近端胃癌行腹腔镜下胃癌D2根治术，根治性近端胃大部切除术清扫1、2、3、4、5、6、7、8、9、11、12a组淋巴结；所有患者均于上腹部做辅助小切口行病灶移除及消化道重建。结果5例均顺利完成腹腔镜下近端胃癌D2根治术，无中转开腹，手术时间：210—330min，平均265min，术中出血量：50—180ml，术中均未输血。排气时间24—54h，平均32h，均于术后第2天经胃管滴注肠内营养液（瑞素），第5天进流食。无吻合口漏及腹腔内出血等并发症。术后病理示所有标本切缘均阴性。随访2～5个月，未见复发和转移。结论腹腔镜下行近端胃癌D2根治术，安全、可行、有效、创伤小且近期效果良好。

Research on Laparoscopic D2 Radical Gastrectomy for Proximal Gastric Carcinoma

Objective To evaluate the feasibihty of laparoscopic D2 radical gastrectomy for proximal gastric carcinoma. Methods From March 2009 to July 2009, ftive patients with proximal gastric carcinoma underwent laparoscopic D2 radical gastrectomy. Groups 1,2,3,4,5,6,7,8,9,11 and 12a lymph nodes were resected during proximal gastrectomy. Reconstruction of the digestive tract was performed through a mini-incision on the upper abdomen after the tumor was removed. Results The procedure was completed in all the patients without conversion to open surgery. The operation time and was 210 -330 minutes （mean,265）, and the intraoperative blood loss was 50 - 180 ml. None of the patients needed blood transfusion. Postoperative pathological examination showed that the edge of the resected samples were negative in all the cases. They recovered in gastrointestinal function in 24 - 54h （mean,32） , received enteral nutrition （Fresubin） in 2 days, and began to take in fliud diets in 5 days. No patients had abdominal hemorrhage and anastomotic leakage or implantations at the incision or puncture site. All the patients were followed up for 2 to 5 months. No recurrence or metastasis was found. Conclusion Laparoscopic D2 radical gastrectomy for proximal gastric carcinoma is a safe, feasible, effective and minimally invasive technique with good short-term outcomes.