腹腔镜胃癌根治术后腹腔游离癌细胞的变化及意义

目的 对比研究腹腔镜与开腹胃癌根治术后腹腔游离癌细胞的变化,探讨腹腔镜胃癌根治术的安全性及可行性.方法 收集2006年4月至2008年6月间63例腹腔镜、61例开腹胃癌根治术患者术前、术后腹腔灌洗液,分别运用细胞学和荧光定量PCR方法 检测腹腔游离癌细胞的阳性率和癌胚抗原(CEA)mRNA的表达变化,观察胃浆膜受侵面积与腹腔游离癌细胞阳性率的关系.结果 腹腔镜组术后腹腔灌洗液游离癌细胞的阳性率为25.4%,与开腹组(29.5%)比较差异无统计学意义(P＞0.05);腹腔镜组术后腹腔灌洗液CEA mRNA阳性率为41.3%,与开腹组(40.3%)比较差异亦无统计学意义(P＞0.05).腹腔镜组术前、术后腹腔游离癌细胞均为阳性的病例,其浆膜平均受侵面积为(16.2±2.2)cm2,而术前、术后游离癌细胞均为阴性的病例,其浆膜平均受侵面积为(5.3±0.8)cm2,腹腔游离癌细胞的阳性率与浆膜受侵面积呈正相关(R2=0.874,P=0.000).结论 腹腔镜胃癌根治术并不增加腹腔游离癌细胞的阳性检出率.     

腹腔镜下进展期胃癌根治术284例

探讨腹腔镜下进展期胃癌根治术的安全性及其近期疗效。回顾性分析284例腹腔镜胃癌根治术患者的临床资料。284例均顺利完成手术,无中转开腹。手术时间:全胃切除260(195~365)min,近端胃切除250(180~325)min,远端胃切除205(155~270)min。术中出血量:全胃切除145(80~420)mL,近端胃切除95(45~320)mL,远端胃切除50(20~215)mL,术中均未输血。清扫淋巴结25.6(11~42)枚。术后患者胃肠功能恢复时间2.6(2~4)d,卧床时间1.4(1~3)d,开始进流质饮食时间2.4(1~4)d。发生吻合口瘘3例,肺部感染8例,穿刺口出血1例,皮下气肿4例。术后随访6~26个月,发生肿瘤穿刺口种植2例,肝转移4例(3例死亡;1例已接受化疗现,一般状况尚可),腹膜转移9例(5例死亡;2例接受化疗,一般状况尚可;2例化疗后全身情况较差),另有6例死于非手术相关疾病。进展期胃癌行腹腔镜根治手术安全、可行,近期疗效令人满意。     

腹腔镜进展期胃癌D_2根治术手术路径的探讨

目的:探讨腹腔镜胃癌D2根治术的手术路径选择。方法:回顾分析为42例患者行腹腔镜胃癌D2根治术的临床资料。结果:42例手术均获成功,无一例中转开腹;其中18例行远端胃大部切除胃空肠Roux-en-Y吻合术,16例行全腹腔镜下远端胃大部切除胃十二指肠毕Ⅰ吻合术,8例行根治性全胃切除食管空肠Roux-en-Y吻合术。手术时间160～310 min,平均(218±34)min;术中出血量30～280 ml,平均(70±42)ml;清扫淋巴结数量16～32枚,平均(26±8)枚;术后分期Ⅰb期7例,Ⅱ期27例,Ⅲa期8例。结论:术者合理站位并选择合理正确的技术路线使腹腔镜胃癌D2根治术操作简便、易行。     

腹腔镜在胃癌根治术的应用进展

近年来有关早期胃癌的微创治疗进展很快，并已取得国内外的共识。对进展期胃癌应用腹腔镜行胃癌根治术尽管已经取得了较好的临床效果，但仍尚待前瞻性多中心临床随机对照研究。从应用前景看，随着术者技术的完善、观念的改变、经验的积累、手术器械的不断改进，腹腔镜胃癌根治术必将在胃癌手术中扮演越来越重要的角色。     

腹腔镜辅助胃癌根治术治疗进展期胃癌42例临床分析

目的探讨腹腔镜辅助胃癌根治术临床疗效。方法回顾性分析2010年1月至2013年7月间收治42例腹腔镜胃癌根治术患者的临床资料。结果42例均成功完成腹腔镜辅助胃癌根治术,其中全胃切除12例,近端胃切除6例,远端胃切除24例。32例行胃癌D2根治术,6例行Dt＋a（De＋第7组淋巴结）根治术,4例行D,＋B（D1＋第7、8a、9组淋巴结）根治术。平均手术时间全胃切除为（310．0±35．5）min,近端胃切除为（260．5±28．5）min,远端胃切除为（200．4±40．2）min。平均术中出血量全胃切除为（270±60）ml,近端胃切除为（220±40）ml,远端胃切为（100±70）ml。术后并发症包括腹腔内出血1例,胃瘫2例,吻合口瘘1例,肺内感染1例。结论腹腔镜辅助下胃癌根治术是治疗进展期胃癌安全、可行且近期疗效良好的手术方法。     

腹腔镜胃癌根治术的应用现状及进展

腹腔镜胃癌根治术已广泛被患者所接受,越来越多的证据显示：对于较早期胃癌行腹腔镜手术治疗具有良好的近期及肿瘤根治疗效.然而,在手术的适应证、生存率及术后生活质量等重要方面仍无明确的定论.本文就腹腔镜胃癌根治术在胃癌中的应用现状及进展进行综述.     

腹腔镜胃癌根治术的围手术期护理

胃癌是我国最常见的消化道恶性肿瘤，多发于40～60岁，男女比例约为3：1，胃癌可发生于胃的任何部分，但多见于幽门或胃小弯侧，通常肿瘤会浸润播散至局部淋巴结或周围脏器，手术切除是其主要治疗手段。腹腔镜胃癌根治术是上个世纪90年代逐渐发展起来的，相对传统开腹手术而言，微创优势明显。2007年6月至2010年6月我科为127例胃癌患者施行腹腔镜胃癌根治术，通过围手术期护理干预，手术及术后恢复均顺利。现将围手术期护理体会报道如下。     

进展期远端胃癌腹腔镜与开腹根治术的对照研究

目的探讨腹腔镜远端胃癌根治术治疗进展期远端胃癌的可行性、安全性及近期疗效．方法回顾性分析2007年1月至2008年6月间135例接受外科手术的远端胃癌患者的临床资料．其中腹腔镜远端胃癌根治术66例．开腹远端胃癌根治术69例。结果腹腔镜组与开腹组患者年龄、性别和TNM分期的差异均无统计学意义（均P〉0．05）。腹腔镜组均在腹腔镜下成功完成根治性胃切除手术,无中转开腹和手术死亡。与开腹组比较,腹腔镜组患者手术时间更长[（266．1±55．1）min比（223．8±26．8）min];但术中出血量更少[（131．9±88．7）ml比（342．3±178．7）ml],术后肠道恢复功能更快[（3．18±1．22）d比（4．50±1．59）d],术后住院时间更短[（9．20±3．39）d比（11．35±4．61）d];差异均有统计学意义（均P〈0．01）。两组清扫淋巴结数目[（25．81±12．53）枚比（27．47±10．28）枚]和术后并发症发生率[6．1％（4／66）比15．94％（11／69）1的差异均无统计学意义（均P〉0．05）。术后随访1～19个月．两组均未见肿瘤复发或肿瘤相关死亡病例。结论腹腔镜远端胃癌根治术是治疗进展期远端胃癌安全、可行、微创、有效的方法。     

腹腔镜辅助下进展期胃癌Dν2根治术的临床分析

目的探讨腹腔镜辅助进展期胃癌D2根治术的可行性和近期疗效。方法分析行腹腔镜辅助进展期胃癌D2根治术的30例患者,包括全胃切除术14例,远端胃大部份切除术16例。结果 30例顺利完成腹腔镜手术,无一例中转。手术平均时间：全胃切除（261.2±22.1）min,远端胃切除（239.8±19.7）min。术中平均出血量：全胃切除（133.3±30.2）ml,远端胃切除（110.4±27.5）ml。清扫淋巴结平均为（21.6±2.3）枚。术后患者胃肠功能恢复时间（3.7±1.1）d,下床活动时间平均（2.6±0.5）d。术后效果良好,无近期并发症。所有患者均获随访,随访时间3～36个月。2例发生肝转移,1例肿瘤复发,未发生Trocar种植及腹膜转移。结论腹腔镜胃癌D2根治术在胃癌患者治疗中,创伤小,恢复快,安全有效,近期疗效好。     

Intracorporeal esophagojejunal anastomosis after laparoscopic total gastrectomy for patients with gastric cancer

Background  To facilitate acceptance of laparoscopic total gastrectomy (LTG) for patients with upper gastric cancer, a simple, secure technique of reconstruction is necessary. The authors developed a new technique for intracorporeal esophagojejunal anastomosis that does not require hand sewing. Methods  From September 2006 to January 2008, 16 patients (11 men and 5 women) with gastric cancer underwent LTG at the authors’ institution. Laparoscopic esophagojejunal anastomosis using the following method was attempted for all patients. The esophagus was transected while being rotated by about 45° counterclockwise to make the subsequent anastomosis easier. After the Y-anastomosis was created, an endoscopic linear stapler was applied to create a side-to-side anastomosis between the left dorsal side of the esophagus and the jejunal limb. The entry hole was first closed roughly with hernia staplers. Subsequently, an endoscopic linear stapler was applied so that all hernia staplers could be removed and the closure completed. Results  Laparoscopic esophagojejunal anastomosis was successfully performed for 15 patients. Intracorporeal anastomosis failed for one patient because a nasogastric tube was caught between the jaws of an endostapler, which resulted in a conversion to open procedure. No postoperative anastomotic complications occurred. Conclusions  Using the new technique, intracorporeal linear-stapled esophagojejunal anastomosis can be performed easily and securely. This technique could become one of the standard methods for reconstruction after LTG, facilitating the acceptance of LTG as a surgical option for patients with upper gastric cancer.     

Total laparoscopic subtotal gastrectomy with transvaginal specimen extraction is feasible in advanced gastric cancer

PurposeNatural orifice specimen extraction (NOSE) is an ever-evolving advanced laparoscopic technique. NOSE minimizes surgical injury, involving a low risk of wound complications, fewer incisional hernias, faster recovery and less postoperative pain. Laparoscopic gastrectomy combined with NOSE is a procedure that can potentiate the advantages of both minimal invasive techniques. We aim to demonstrate the feasibility of laparoscopic subtotal gastrectomy with transvaginal specimen extraction in advanced gastric cancer.CaseA 72-year-old woman with a 2 cm adenocarcinoma in gastric antrum was treated by laparoscopic subtotal gastrectomy and lymph node dissection. A totally laparoscopic Roux-en-Y gastrojejunostomy was constructed. Specimen was extracted through the posterior fornix of vagina without difficulty. Histopathology confirmed pT3pN0 tumor. After a 10-month follow-up the patient was asymptomatic and getting adjuvant chemoradiotherapy.ConclusionsTransvaginal specimen extraction after laparoscopic gastric resection for advanced gastric cancer is a feasible procedure. It is offered to selected patients and of course only to female patients. Natural orifice surgery may provide faster recovery and decrease the wound related complications which may cause a delay on postoperative adjuvant chemo–radio therapies. We have presented, as far as we know, the first human case of a transvaginal extraction of an advanced gastric cancer after laparoscopic gastrectomy.     

Short-term efficacy of laparoscopy-assisted vs open radical gastrectomy in gastric cancer

AIM:To investigate the short-term benefits of laparoscopic radical gastrectomy(LARG)and open radical gastrectomy(ORG)in patients with gastric cancer.METHODS:A total of 400 patients with gastric cancer aged≤65 years who were treated at General Hospital of Lanzhou Military Region were enrolled.Among these,200 patients underwent LARG between October2008 and August 2012(LARG group);and 200 patients underwent ORG between March 2000 and September2008(ORG group).The short-term therapeutic benefits between the two groups were analyzed.RESULTS:The LARG procedure offered significantly better benefits to the patients compared to the ORG procedure,including less intraoperative blood loss(103.1±19.5 mL vs 163.0±32.9 mL,P0.0001),shorter postoperative hospital stay(6.8±1.2 d vs 9.5±1.6 d,P0.0001),less frequent occurrence of postoperative complications(6.5%vs 13.5%,P=0.02),shorter time to mobilization(1.0±0.3 vs 3.3±0.4 d,P0.0001),shorter time to bowel opening(3.3±0.7 d vs 4.5±0.7 d,P0.0001),and shorter time to normal diet(3.0±0.4 vs d 3.8±0.5 d,P0.0001).However,LARG required a longer time to complete than the ORG procedure(192.3±20.9 min vs 180.0±26.9 min,P0.0001).CONCLUSION:Compared to ORG,LARG is safer,more effective,and less invasive for treating gastric cancer,with better short-term efficacy.     

腹腔镜辅助与开腹远端胃癌D2根治术的治疗效果比较

目的 探讨腹腔镜辅助远端胃癌D2根治术的治疗效果.方法 分析2008年11月至2011年10月行腹腔镜辅助和开腹远端胃癌D2根治术患者的临床资料,其中腹腔镜组61例,开腹组37例作为对照.结果 56例顺利完成腹腔镜手术,5例中转,手术时间:腹腔镜组(178.00±15.51) min,开腹组(147.86±17.41) min;术中出血量:腹腔镜组(138.43±39.67) ml,开腹组(362.86±59.86) ml(P＜0.05);平均切口长度:腹腔镜组(5.12±0.85)cm,开腹组(18.40±1.98) cm;两组在淋巴结清扫数量上差异无统计学意义(P＞0.05).开腹组术后发生5例肺部感染,腹腔镜组发生3例肺部感染,差异无统计学意义(P＞0.05).根据术后病检回报:两组均达到了癌肿的整块切除.规律随访得知所有患者均存活,未发现有远处转移.结论 腹腔镜辅助胃癌D2根治手术可以达到根治和微创的双重效果,其远期疗效有待进一步随访观察.     

Comparison of laparoscopically assisted and open radical distal gastrectomy with extended lymphadenectomy for gastric cancer management

Background The feasibility and safety of laparoscopically assisted gastrectomy with extended lymphadenectomy for advanced gastric cancer has rarely been studied. This study aimed to investigate the feasibility, safety, and cancer clearance of laparoscopically assisted distal gastrectomy with D2 lymphadenectomy. Methods Of the 44 patients with distal gastric cancer who underwent radical distal gastrectomy from March 2004 to May 2005, 35 were treated with D2/D2⁺ lymphadenectomy. These patients were compared with 58 patients who, during the same period, underwent a conventional open radical distal gastrectomy. Results The mean total number of retrieved lymph nodes (30.11 ± 16.97) and the mean tumor margin were comparable with those in the open group. The mean operative time for laparoscopically assisted distal gastrectomy was significantly longer than for open surgery (282.84 ± 32.81 min vs 223.75 ± 23.25 min). The patients in the laparoscopic surgery group had less blood loss, shorter times of analgesic injection, and a faster recovery. The rates of complications were comparable between two groups. Conclusions Although laparoscopically assisted radical gastrectomy with D2 lymphadenectomy is more time consuming than open surgery, it is a safe, feasible procedure that achieves cancer clearance similar to open surgery and leads to a quick postoperative recovery.     

Laparoscopically assisted distal gastrectomy with standard radical lymph node dissection for gastric cancer

Background Laparoscopically assisted distal gastrectomy (LADG) with limited lymph node dissection (D1+alpha) has been used to treat a subset of patients with early gastric cancer. Technical advances have expanded indications for LADG to more advanced gastric cancers. However, little data are available on the feasibility or advantages of LADG with standard radical D2 lymph node dissection for patients with gastric cancer. Methods This study reviewed the clinical features of 37 patients who underwent LADG with D2 lymph node dissection for preoperatively diagnosed gastric carcinoma, then compared the results with the features of 31 patients who underwent conventional open distal gastrectomy (ODG) with D2 lymph node dissection. Results The laparoscopic procedure was not converted to laparotomy in any patient. There was no operative mortality and no serious morbidity among the patients who underwent LADG with D2 lymph node dissection. As compared with the ODG group, the LADG group had less operative blood loss (p < 0.001), earlier recovery of bowel activity (p = 0.012), and a shorter duration of fever after surgery (p = 0.015), despite the longer operation time (p = 0.007). Conclusions According to this study, LADG with D2 lymph node dissection is feasible and provides several advantages similar to those of limited lymph node dissection (D1+alpha). Depending on surgeons’ technical proficiency, LADG can be used with standard radical lymph node dissection for patients with gastric cancers.     

经脐单孔腹腔镜胃癌D2根治术

目的探讨经脐单孔腹腔镜胃癌D2根治术的可行性、安全性和治疗效果。方法患者女,53岁,病理回报为胃窦腺癌,于2011年6月17日应用常规的腹腔镜器械行经脐单孔腹腔镜胃癌D2根治术,患者气管插管全身麻醉满意后,于脐下缘取3em弧形切口建立气腹,探查腹腔,游离胃大弯,用腹腔镜直线切割吻合器离断十二指肠及远端胃,在距十二指肠悬韧带40em空肠处切一小口,行胃空肠吻合、空肠空肠吻合。结果成功的应用常规腹腔镜器械完成了经脐单孔腹腔镜下根治性胃癌切除术,D2式淋巴结清扫。手术时间为185min,术中失血量为146ml,患者术后3d排气下床活动,5d进流食,引流管于术后6d拔除,术后住院13d。随访4个月,无并发症发生。结论经脐单孔腹腔镜胃癌D2根治术是安全、有效、可行的,但仍需更多病例的研究证实。     

全腹腔镜根治性全胃切除术的临床应用研究

目的探讨全腹腔镜下根治性全胃切除术临床应用的可行性、安全性以及近期疗效。方法回顾分析2008年1月至2012年12月间接受外科根治性全胃切除术139例患者的临床资料。其中全腹腔镜根治性全胃切除术69例,开腹根治性全胃切除术70例。腹腔镜组和开腹组患者的年龄、性别及临床TNM分期差异均无统计学意义（P〉0．05）,所有患者均是接受同一组医师手术。结果69例腹腔镜手术均顺利完成,无中转开腹或腹腔镜辅助,无手术死亡。平均切口长度4．3cm,较开腹15．1Cm短;平均手术时间（305．0±60．2）min,较开腹组（263．6±30．6）min长;平均术中出血（142.3±82.-3）ml,较开腹组（35213±153．2）ml少;术后肛门排气时间平均（4．2±1．5）d,较开腹组（9．4±3．5）d短,术后平均住院（10．22±2．5）d,较开腹组（13．1±4．6）d短,两组的差异均具有统计学意义（P〈0．01）：而平均清扫淋巴结数目（24.3±12．2）枚,开腹组（25．1±10．9）枚;术后并发症发生率7．2％,开腹组12．9％,两组的差异无统计学意义（P〉0．05）。术后随访3～24个月,两组均无肿瘤复发和死亡病例。结论全腹腔镜根治性全胃切除术治疗胃上、中部癌安全可行,并能达到肿瘤根治的要求,具有创伤小、出血少、康复快等优点。     

Long-term quality of life after laparoscopy-assisted distal gastrectomy for gastric cancer

Background Laparoscopy-assisted distal gastrectomy (LAG) is gaining acceptance for treating early gastric cancer. However, the long-term quality of life after LAG for gastric cancer is unknown. This study compared the long-term quality of life after LAG versus open distal gastrectomy (ODG) for early gastric cancer. Method This study included 53 patients who underwent LAG and 37 patients who underwent ODG for treatment of early gastric cancer. Quality of life was evaluated on the basis of a 22-item questionnaire that addressed food tolerance and mental and physical conditions, scored on a scale of 1–3. Results The mean follow-up periods after LAG and ODG were 99.3 and 97.0 months, respectively. Although the majority of patients who had undergone LAG were consuming a normal diet and had weight loss of less than 5 kg, all 22 items and the total score of the LAG group were comparable to those of the ODG group. However, the incidence of postoperative intestinal obstruction was significantly lower in the LAG group than in the ODG group (1% vs. 13%, p < 0.05). Conclusions LAG is equivalent to ODG with respect to long-term quality of life and is associated with a reduced incidence of postoperative intestinal obstruction. This work was supported in part by a Grant-in-Aid for Scientific Research (No. 15390401) from the Japanese Ministry of Education, Science, and Culture