腹腔镜胃癌根治术的现状与前景

胃癌是常见的消化道恶性肿瘤之一,在我国早期胃癌所占比例很小,约90%的病例确诊时已为进展期胃癌。随着内镜、B超、超声内镜等诊疗技术的发展,早期胃癌的诊出率逐渐增多,日本约50%的胃癌为早期胃癌。胃癌的微创治疗包括内镜下胃黏膜切除术、腹腔镜胃腔内黏膜切除术、腹腔镜胃楔形切除术,腹腔镜胃癌根治术也随之得到了较大的发展。1993年Ohgami报道了腹腔镜胃楔形切除术,1994年Ohashi报道了腹腔镜胃腔内黏膜切除术用于治疗无淋巴结转移风险的早期胃癌患者,取得了较好的临床疗效,但由于这两种手术方式均不对胃周淋巴结进行清扫,其应用范围比…     

腹腔镜胃癌根治术治疗进展期胃癌的现状与临床研究

不同于日、韩等国家,我国胃癌病例大多以进展期胃癌为主.手术根治作为胃癌的主要治疗手段,近年来取得了很大发展,特别是腹腔镜胃癌根治术的发展.然而针对于腹腔镜胃癌根治术应用于进展期胃癌治疗的诸多方面,在国内外仍存在较大争议,特别是在手术适应证、具体术式以及重建方法选择、镜下完成D2淋巴结清扫以及术后的近期疗效与远期肿瘤学疗...     

腹腔镜胃癌手术的进展与展望

1994年日本Kitano等[1]首次报道了腹腔镜胃癌根治术,相对于传统的胃癌根治术,具有明显的微创优势。腹腔镜早期胃癌根治术经过10余年的发展,技术上已逐渐成熟,取得了与开腹手术相当的近、远期疗效[2]。1997年Goh等[3]将腹腔镜胃癌     

腹腔镜胃癌根治手术中的团队配合

目的探讨团队配合在腹腔镜胃癌根治手术中的重要性及技巧。方法对2008年1月-2008年10月32例腹腔镜胃癌根治临床的临床资料进行分析。主刀医生及扶镜助手,第一助手在相应的手术区域,采用基本固定的配合模式,分别完成胃结肠韧带、脾胃韧带、肝胃韧带的离断,小网膜囊的完整切除及各组淋巴结的清扫,并在体腔外完成病灶的切除,消化道的重建。结果32例均在腹腔镜下完成手术,远近端胃癌根治性切除术时间250-390 min,平均325 min。全胃根治性切除300-450 min,平均347min。术中出血量：远、近端胃癌根治性切除术50-250 ml,全胃根治性切除术60-350 ml,术中均未输血。所有标本切缘均阴性,清扫淋巴结13-35枚,平均21枚。术后排气时间24-72 h,平均38 h。进流质时间2-5 d,平均2.8 d。27例术后随访1-8个月,未见复发和转移,未发生切口和穿刺口种植。结论密切的团队配合是顺利完成腹腔镜胃癌根治手术的必要条件,对缩短手术时间,减少术中出血及保证根治效果具有重要意义。     

有腹部手术史病人的腹腔镜胃癌手术

正腹腔镜技术在胃肠道手术中早期应用时,被关注的主要是其肿瘤学疗效,如手术的规范化和淋巴结清扫的彻底性。随着手术技术的提高和经验的积累,腹腔镜技术逐渐应用于既往有腹部手术史的胃癌病人。对既往有腹部手术史(无论腹腔镜还是开腹手术)的病人行腹腔镜再次手术,统称为微创再次手术(reoperative minimally invasive surgery,RMIS)~([1])。胃肠道手术原本就较复杂,对于有腹部手术史的病人行胃     

腹腔镜胃癌根治术治疗进展期胃癌

腹腔镜手术用于胃癌治疗最早由Kitano等^[1]报道,由于其具有切口小、术中失血量少、疼痛程度轻、术后炎症反应轻、胃肠道功能恢复快、美容等一系列微创的优点,腹腔镜手术迅速在世界各国蓬勃开展起来。但是在腹腔镜胃癌根治术发展的起步阶段,该手术主要应用于早期胃癌的治疗。 然而,在进展期胃癌中,因为肿瘤侵犯层次深、肿瘤瘤体较大、胃周淋巴结转移概率高等问题,是否可运用腹腔镜胃癌根治术仍存在多方面的争议。本文就此谈谈我们的体会。     

开腹和腹腔镜胃癌根治对比

目的比较开腹和腹腔镜胃癌根治患者围手术期的相关指标的差异,进一步探讨差异存在的主要原因。方法采用回顾性研究,对2011年1月至2014年12月收治的胃恶性肿瘤行手术治疗的183例患者进行对比分析,其中67例行开腹胃癌根治术(开腹组),116例行腹腔镜胃癌根治术(腹腔镜组)。结果开腹组和腹腔镜组的手术时间比较,差异无统计学意义(P0.05),但开腹组术中出血量多于腹腔镜组,术后恢复过程中,两组的术后第1天、术后第3天和术后第5天的白细胞、红细胞、血红蛋白、白蛋白、血小板的变化比较,差异有统计学意义(P0.05),同时两组的术后输血、血浆和白蛋白量,以及腹腔引流总量、腹腔引流管拔除时间、患者术后排气时间、下床活动时间和住院时间比较,差异均有统计学意义(P0.05)。结论腹腔镜下胃癌根治术患者的围手术期相关指标优于开腹胃癌根治术。     

腹腔镜远端胃癌D_2根治术手术路径的临床应用研究

目的探讨腹腔镜远端胃癌D2根治术手术路径的临床效果。方法 2007年10月-2010年5月,对56例远端胃癌实施腹腔镜远端胃癌D2根治手术。手术路径：大网膜切除和横结肠系膜前叶剥离;解剖腹腔动脉、肝总动脉、脾动脉及清扫相应淋巴结;处理胃右动脉和5组淋巴结;清扫12a组淋巴结等顺序进行,淋巴清扫以4d→4sb→14v→6→7/9→11p→8a→5→12a→1→3的路径进行。结果手术时间130-375 min,（203.4±48.4）min。清扫淋巴结13-21枚,（16.2±1.2）枚。术后胃肠功能恢复时间48-120 h,（80.6±17.7）h。标本远近切缘无癌残留。无围手术期死亡病例。术后72 h吻合口出血1例,96 h输出端梗阻1例。56例术后随访2-31个月,（14.1±6.9）月,死亡8例：肿瘤广泛转移6例,心脑血管疾病2例;带瘤生存5例,无瘤生存43例,无瘤生存时间最长已31个月。结论腹腔镜远端胃癌D2根治术按照合理的路径进行手术,能够保证手术在正确的间隙和解剖层面进行,有利于在遵循肿瘤根治的原则下完成手术。     

腹腔镜与开腹手术治疗胃癌的比较研究

目的：通过比较同期开展的腹腔镜胃癌根治术与传统开腹胃癌根治术,评价腹腔镜胃癌根治术的效果,以期为腹腔镜胃癌手术的进一步开展提供参考依据。方法：选取2008年9月—2010年6月接受手术的178例胃癌患者为研究对象,其中106例采用传统开腹胃癌根治术（传统开腹组）,72例患者接受腹腔镜胃癌根治术（腹腔镜手术组）。腹腔镜手术组与传统开腹组在性别、年龄、肿瘤位置、病理类型和TNM分期差异无统计学意义。结果：2组在手术时间、出血量、胃肠道恢复时间、术后首次进食流质时间和术后住院时间差异有统计学意义。结论：腹腔镜胃癌手术较传统胃癌手术具备了切口小、出血量小,胃肠道恢复时间短、术后住院时间缩短等优势。     

腹腔镜远端胃癌D2根治手术的路径

目的:探讨腹腔镜端胃癌D2根治术的合理手术路径.方法:分析23例行腹腔镜端胃癌D2根治手术治疗的手术路径.结果:23例中22例完成腹腔镜手术,手术时间平均(232±35)min,术中出血平均(130±50)mL,平均清扫淋巴结(19±5)枚,术后胃肠功能恢复时间2~4 d.结论:腹腔镜端胃癌D2根治手术遵循从下到上、从右到左、从胃大弯到胃小弯的操作顺序是合理、可行的,淋巴清扫时,胰腺是手术操作的主要解剖定位标志,胃十二指肠动脉是最重要的血管定位标志.     

Laparoscopic gastric reduction surgery

BACKGROUND: The purpose of the current study was to present the preliminary results of a randomized prospective trial comparing laparoscopic and open vertical banded gastroplasty (Mason's procedure). METHODS: From April 1995 to April 1996, 68 patients (9 men and 59 women, mean age, 36 years; ranges, 17-60 years) affected from morbid obesity (mean body weight, 123 kg; range, 89-188 kg; mean body mass index (BMI), 43 kg/m2; range, 37-66 kg/m2) were enrolled in a prospective trial and randomly assigned to a laparoscopic (group A) or open (group B) Mason's gastroplasty. There was no statistically significant difference between the two groups in terms of patient epidemiologic data. The significance level among the data was assessed by means of Fisher's exact test. RESULTS: The success of laparoscopic gastroplasty was 88.2% (30/34). The intervention was significantly longer in the laparoscopic group (150 min vs. 60 min; p = 0.001). No mortality was recorded in the overall population. Intraoperative complications included only one case of gastric bleeding in group A (2.9% vs. 0%; p value not significant [NS]). Early major complications ranged as high as 6.6% and 7.8%, respectively, in groups A and B (p = NS), and included one case of peritonitis and one case of pneumonia in group A, and two cases of peritonitis and one pulmonary embolism in group B. Early minor postoperative complications consisted of wound infections only, observed in one group A patient (3.3%) and four group B patients (10. 8%, p = 0.04). At longer follow-up, incisional hernias occurred in 15.8% (6/38) of patients surgically treated with a conventional approach compared with none among those successfully surgically treated with laparoscopic access (p = 0.04). No statistically significant difference was observed between the two groups regarding the efficacy of the procedure, in terms of decrease in percentage of excess body weight, mean body weight, or mean BMI. CONCLUSIONS: The preliminary results of current study show that the laparoscopic Mason procedure is a time-consuming and technically demanding operation, as effective as its traditional counterpart, but carrying a statistically significant decrease in the incidence of wound infections and incisional hernias.     

胃癌的腹腔镜手术

近年来,随着腹腔镜技术的不断发展完善以及外科医生对微创理念的认识加深,腹腔镜技术在胃癌治疗中的应用越来越广泛.我们根据自身累积的经验和认识,就腹腔镜在胃癌治疗中的应用现状及进展作简要的论述.     

Laparoscopic gastric surgery. Early experiences

In the Department of General Surgery the authors performed 12 elective laparoscopic gastric operations for gastric pathologies. The indications for the procedures were recurrent or therapy resistant and complicated peptic ulcer in 9 cases, benign gastric tumors in 2 cases and early gastric cancer in 1 case. Operative procedures were the next: posterior truncal vagotomy with anterior lesser curve seromyotomy (5 patients), total truncal vagotomy with gastrojejunostomy (2 patients), total truncal vagotomy with pyloroplasty (1 patient), total truncal vagotomy with antrectomy and Billroth-II reconstruction (1 patient), resection of benign gastric tumor by the transgastric approach (1 patient), Billroth-II resection for benign gastric tumor (1 patient), wedge resection of gastric wall for early gastric cancer (1 patient). Intraoperative gastroscopy was used for location of the lesion in 4 of 12 cases. Apart from delayed gastric emptying (2 cases), patients recovered without any problem. The mean hospital stay was 5.7 days. Early experiences with laparoscopic gastric surgery has shown that there are certain important advantages to the approaches. They hold the promise of less pain, less immobility, quicker alimentation, shorter hospitalization, less wound and respiratory complications and an earlier return to normal activities.     

Laparoscopic revision of gastric band surgery

Aim: To identify the outcome of laparoscopic revision of gastric band surgery with respect to percentage of excess weight lost (%EWL). Methods: Analysis of a prospective database was then performed and %EWL was plotted with respect to time from initial procedure and also time from revision procedure. Results: All revision operations were performed laparoscopically. There were no patient deaths, but two serious complications. Percentage excess weight loss after replacement of the band because of prosthetic failure or dysphagia was 57% at an average follow‐up of 19 months. For repositioning of the band due to slippage, the %EWL was 72% at an average of 15 months follow‐up for those who had the existing band repositioned, and 42% at an average of 23 months follow‐up for those who had a new band repositioned. Conclusion: Revision laparoscopic gastric band surgery is a safe option for patients, and results in good %EWL at an average follow‐up period of 19 months.     

腹腔镜在胃上部癌手术中的应用

<正>胃上部癌是指发生于胃上1/3的癌,包括非贲门胃上部癌和贲门癌,前者癌中心位于胃底及胃小弯上的1/3,后者癌中心位于胃-食管接合部上下2cm以内[1]。胃上部癌发生率虽低于胃窦及胃小弯癌,但近年有逐渐上升的趋势[2]。     

腹腔镜手术治疗胃间叶源性肿瘤的临床研究

目的:探讨腹腔镜手术治疗胃间叶源性肿瘤的临床应用价值。方法:回顾性分析2008年3月至2010年10月间接受腹腔镜手术的35例胃间叶源性肿瘤病人的临床资料,包括手术方式、手术时间、术中出血量、术后住院时间、并发症、术后病理及随访结果等。结果:所有手术均在腹腔镜下完成,其中使用内镜下线型切割闭合器行腹腔镜胃部分切除术27例,腹腔镜辅助远端胃大部切除术4例,腹腔镜辅助近端胃大部切除术4例。8例手术采用术中胃镜的双镜治疗。无一例中转开腹手术。中位手术时间90(60~160)min,术中平均出血量(42.1±23.6)(10~200)mL,肿瘤平均大小(35.4±13.5)(10~62)mm,肿瘤切缘术中冷冻及术后石蜡病理均为阴性。术后病理胃间质瘤26例、胃神经鞘瘤5例、胃平滑肌瘤2例、胃脉管瘤1例、胃纤维母/肌纤维母细胞瘤1例。术后平均住院时间(6.3±1.3)(4~10)d,无术后并发症。术后中位随访时间22(12~43)个月,所有病人均无肿瘤复发及远处转移。结论:腹腔镜手术切除胃间叶源性肿瘤是安全、微创、有效的,应作为此类肿瘤治疗的首选方法。     

腹腔镜手术治疗胃的胃肠间质瘤

胃肠问质瘤（gastrointestinalstromaltumor,GIST）是消化道最常见的问叶组织源性肿瘤,因该肿瘤独特的生物学行为和临床特征,外科手术和分子靶向治疗是胃GIST主要治疗手段。腹腔镜技术因其具有微创的特点。已逐渐用于胃GIST的手术治疗,并成为胃GIST外科治疗的发展趋势。本文就规范实施腹腔镜胃GIST手术中．需掌握的手术适应证、手术原则、手术方式、术中定位以及外科联合靶向药物治疗原则等进行论述,以期为临床治疗提供参考。