腹腔镜辅助胃癌根治术24例

目的探讨腹腔镜辅助胃癌根治术的效果。方法2009年1月～2011年12月，行腹腔镜辅助根治性胃切除术24例。腹腔镜下探查腹腔、清除大网膜及预定范围的淋巴结，通过上腹部小切口完成胃肿瘤切除和胃肠重建。结果中转开腹手术1例。余23例完成腹腔镜手术，其中根治性全胃切除术6例，近端胃大部切除术3例，远端胃大部切除术14例。手术时间全胃（171．0±32．5）min，近端胃130、185及210min，远端胃（137．2±40．2）min。术中出血量：全胃（260±80）ml，近端胃190、220、250ml，远端胃（190±50）ml。清除淋巴结（18．4±4．3）枚。术后排气时间（1．4±0．8）d。术后住院时间（12．0±3．4）d。术后随访12～24个月，平均16．3月。复发率21．7％（5／23）。结论腹腔镜胃癌根治术可行、可靠，能够达到与开腹手术相当的根治效果，且具有创伤小、术后恢复快等优点。

A Report of 24 Cases of Laparoscopic-assisted Radical Gastrectomy

Objective To discuss the efficacy of laparoscope-assisted radical gastrectomy for gastric cancer. Methods From January 2009 to December 2011, 24 patients with gastric cancer underwent laparoscopy-assisted radical gastrectomy. After exploring the abdominal cavity, removing the greater omentum and expected lymph nodes via laparoscopy, we resected the gastric tumor and rebuilt gastric intestine via a small midline upper abdominal incision. Results Of the 24 cases, 1 case was converted to open surgery and the other 23 cases went through laparoscopy-assisted surgery, including 6 cases of total radical gastrectomy, 3 cases of proximal gastrectomy, and 14 cases of distal gastrectomy. The average operation time was （171.0 ± 32.5） rain in total gastrectomy, 130, 185 and 210 min in proximal gastreetomy, and （ 137.2 ±40.2） rain in distal gastrectomy. Blood loss： （260 ± 80） ml in total gastrectomy, 190,220 and 250 ml in proximal gastreetomy respectively and （190 ± 50） ml in distal gastrectomy. The average number of lymph nodes dissected was 18.4 ± 4.3 per case. The average time of first postoperative flatus was （ 1.4 ± 0.8 ） d and the mean time of hospital stay was （12.0± 3.4） d. All cases were followed up for 12-24 months, with an average of 16.3 months. The rate of postoperative recurrence was about 21.7% （5/23）. Conclusions Laparoscope-assisted radical gastrectomy is safe and feasible for gastric cancer with minimal invasion and quick postoperative recovery. It has similar effects as compared with open surgery in curing the disease.