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1.
Laparoscopic distal gastrectomy with regional lymph node dissection for gastric cancer 总被引:20,自引:3,他引:17
Recently, a minimally invasive operation for gastric malignancies has been advocated, and the laparoscopic operation is noted as a technique that increases the quality of life. We performed distal gastrectomy with regional lymph node dissection on 160 cases of gastric cancer located in the middle or lower third of the stomach. In 123 cases, Billroth I reconstruction was performed intracorporeally using the quadrilateral (square) stapling technique with a laparoscopic linear stapling device to prevent postoperative anastomotic bleeding and stenosis. In the remaining 37 cases, the Billroth II method was performed with a linear stapling device [1]. This technique is not only less invasive but also as safe as open gastrectomy, which was performed on 100 gastric cancer cases of similar staging. 相似文献
2.
Laparoscopic distal gastrectomy with regional lymph node dissection for gastric cancer 总被引:23,自引:4,他引:19
Tanimura S Higashino M Fukunaga Y Kishida S Nishikawa M Ogata A Osugi H 《Surgical endoscopy》2005,19(9):1177-1181
Background Recent advances in surgical techniques have led to widespread acceptance of laparoscopic gastrectomy for gastric cancer. We
performed distal gastrectomy with regional lymph node dissection in 235 patients with gastric cancer located in the middle
and lower third of the stomach.
Methods In 171 cases, reconstruction was done using the Billroth I method intracorporeally and the aid of laparoscopic linear stapling
devices. The Billroth II and Roux-en-Y methods were used in the remaining 56 and eight patients, respectively,
Results Patients who underwent laparoscopic distal gastrectomy had a more rapid postoperative recovery than those treated via the
open approach. Postoperative complications with this technique were within a permissible range. In terms of the survival curve,
there was no statistical difference between the laparoscopic group diagonesed as clinical T2N0 (c T2N0) Preoperatively and
the open group.
Conclusion The laparoscopic technique is not only less invasive, but is also similarly safe and curative compared to open gastrectomy. 相似文献
3.
Sakuramoto S Kikuchi S Kuroyama S Futawatari N Katada N Kobayashi N Watanabe M 《Surgical endoscopy》2006,20(1):55-60
Background Laparoscopy-assisted distal gastrectomy (LADG) is gaining wider acceptance for the treatment of early gastric cancer. However,
firm evidence supporting its safety and usefulness is scant, and no study has compared the outcomes of various procedures
for LADG. We examined the surgical outcomes of LADG performed using different methods for lymph node dissection.
Methods Between September 1998 and January 2005, we performed LADG in 111 patients with early gastric cancer. In the 55 patients treated
initially, group 2 lymph node dissection was performed through a small, 7-cm-long incision (minilaparotomy). In 43 of these
patients, hand-assisted laparoscopic surgery (HALS) was done. In the 56 patients treated more recently, lymph node dissection
was performed laparoscopically. In 31 of these patients, the celiac branches of the vagus nerve were preserved. Clinical outcomes
of these procedures were compared.
Results In the first 55 patients, HALS significantly shortened the operation time (277 vs 243 min, p < 0.05). In the latter 56 patients, LADG with preservation of the celiac branches of the vagus nerve was associated with
a longer operation time (283 vs 228 min, p < 0.01) and higher blood loss (150 vs 92 g, p < 0.05) than with LADG without celiac branch preservation. There were no differences among the various operative procedures
in postoperative course, including the length of the postoperative hospital stay or the rate of complications.
Conclusions LADG is a safe and technically feasible procedure for the treatment of early gastric cancer. Laparoscopic lymph node dissection
provided a good visual field and was easier to perform and required less time when the celiac branches of the vagus nerve
were not preserved, with no negative effect on outcome. 相似文献
4.
Tatsushi Suwa Masashi Yoshida Keisuke Kubota Junko Kuroda Masayoshi Sakuma Masaki Kitajima 《Surgery today》2009,39(1):83-87
Laparoscopy-assisted gastrectomy with extraperigastric lymph node dissection for gastric cancer is a complicated procedure
that generally requires advanced laparoscopic surgical skill. We devised a simplified but effective laparoscopic procedure
that provides a better visual field to perform safe lymph node dissection more quickly. First, a mini-laparotomy is done and
a clear visual field is created by pulling a mini-retractor to the right or left. The laparoscopic procedure is made easier
and safer by taping the stomach body, and by using the fringe of an abdominal wall sealing device (Lapdisk) placed behind
the stomach, and a scope holder for the snake-retractor. The lymph nodes along the common hepatic vessels, left gastric vessels,
and celiac artery (extraperigastric lymph nodes) are then dissected laparoscopically. The suprapyloric and infrapyloric lymph
nodes are dissected through the mini-laparotomy incision and gastroduodenostomy is done using an anastomotic device. We performed
laparoscopy-assisted distal gastrectomy (LADG) in 70 patients with gastric carcinomas located in the distal stomach (mean
body mass index: 24.3). The mean operating time was 170 min and blood loss was minimal. All patients recovered well with minimal
pain and good postoperative quality of life. We conclude that our simple and practical procedure for LADG with extraperigastric
lymph node dissection can be performed safely and easily. 相似文献
5.
Laparoscopically assisted distal gastrectomy with standard radical lymph node dissection for gastric cancer 总被引:9,自引:5,他引:9
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. 相似文献
6.
Mochiki E Toyomasu Y Ogata K Andoh H Ohno T Aihara R Asao T Kuwano H 《Surgical endoscopy》2008,22(9):1997-2002
Background In recent years, laparoscopic gastrectomy has been applied for the treatment of gastric cancer in Japan and Western countries.
This report describes the short- and long-term results for patients with gastric cancer who underwent laparoscopically assisted
total gastrectomy (LATG) with lymph node dissection.
Methods From September 1999 to December 2007, 20 patients underwent LATG, and 18 underwent conventional open total gastrectomy (OTG)
for upper and middle gastric cancer. The indications for LATG included depth of tumor invasion limited to the mucosa or submucosa
and absence of lymph node metastases in preoperative examinations. The LATG and OTG procedures for gastric cancer were compared
in terms of pathologic findings, operative outcome, complications, and survival.
Results No significant difference was found between LATG and OTG in terms of operation time (254 vs 248 min.), number of lymph nodes
(26 vs 35), complication rate (25% vs 17%), or 5-year cumulative survival rate (95% vs 90.9%). Differences between LATG and
OTG were found with regard to blood loss (299 vs 758 g) and postoperative hospitalization (19 vs 29 days).
Conclusion For properly selected patients, laparoscopically assisted total gastrectomy can be a curative and minimally invasive treatment
for early gastric cancer. 相似文献
7.
Background There has been a trend toward minimally invasive treatment of early gastric cancer. We report the preliminary results of laparoscopy-assisted
distal gastrectomy with laparoscopic sentinel lymph node biopsy after endoscopic mucosal resection.
Methods Six patients underwent laparoscopy-assisted distal gastrectomy after endoscopic mucosal resection between February 2002 and
October 2005 at Mie University Hospital. These patients first underwent laparoscopic sentinel lymph node biopsy and then laparoscopy-assisted
distal gastrectomy with lymphadenectomy.
Results No patient underwent conversion to open surgery during the operation. None of the patients had any postoperative complications.
The mean length of postoperative hospital stay was 11.3 days. Sentinel lymph nodes were identified laparoscopically in five
patients. There were 20 sentinel and 85 nonsentinel lymph nodes in the six patients. Postoperatively, tissue sections showed
that none of the lymph nodes were metastasized. Immunohistochemistry with D2-40 antibody showed that there were normal lymphatics
in the submucosal layer with mucosal defects at the endoscopic mucosal resection site. No patients had any tumor recurrence
during followup.
Conclusions Laparoscopy-assisted distal gastrectomy after endoscopic mucosal resection was a safe and curative procedure. Endoscopic mucosal
resection before sentinel lymph node biopsy was acceptable for early gastric cancer. 相似文献
8.
陈上保 《岭南现代临床外科》2011,11(4):248-250
目的 探讨腹腔镜辅助在小切口下胃癌D2根治术中的应用价值。方法 回顾分析30例患者行腹腔镜辅助在小切口下胃癌D2根治术的临床资料。结果 30例均顺利完成腹腔镜辅助小切口胃癌D2根治术,无中转开腹。根治性近端胃大部切除8例,手术时间(231±21)min,术中出血量(163±23)mL;根治性全胃切除6例,手术时间(322±25)min,术中出血量(320±28)mL。根治性远端胃大部切除16例,手术时间(203±26)min。结论 腹腔镜辅助在小切口下胃癌D2根治术在保留腹腔镜手术微创优点的同时降低了全腹腔镜胃癌根治术的手术难度,获得开腹手术相当的临床疗效。具有良好的床应用价值。 相似文献
9.
腹腔镜辅助胃远端癌淋巴结清扫术近期疗效 总被引:3,自引:3,他引:3
目的探讨腹腔镜辅助胃远端癌D2淋巴结清扫术的可行性及近期疗效。方法2007年1月至2008年12月,对241例胃远端癌患者施行D2淋巴结清扫术。其中腹腔镜辅助远端胃大部切除术(LADG组)93例,常规开腹远端胃大部切除术(ODG组)148例。比较两组患者的淋巴结清扫数及术中、术后恢复情况、并发症发生率和住院死亡率。结果LADG组和ODG组患者淋巴结清扫数分别为(27.5±9.1)枚和(27.3±8.5)枚,两组差异无统计学意义(P〉0.05)。按肿瘤浸润深度进行分层分析,T1、T2、T3期患者两组平均清扫淋巴结数差异均无统计学意义(P〉0.05)。LADG组手术时间显著长于ODG组,但术中出血量、输血例数、术后首次下床时间、肛门排气时间、进流质时间、住院时间和手术并发症发生率均显著少于ODG组,两者差异有统计学意义(P〈0.05)。结论腹腔镜辅助胃远端癌D2淋巴结清扫术在淋巴结清扫方面能达到与开腹手术相同的效果,且具有安全、术后恢复快和并发症少等优点。 相似文献
10.
Purpose It is generally considered difficult to operate on overweight patients, who are also at increased risk of postoperative complications.
We conducted this study to clarify the technical feasibility and postoperative outcomes of laparoscopy-assisted distal gastrectomy
(LADG) for early gastric cancer (EGC) in overweight patients.
Methods Between July 2004 and December 2006, 116 patients with preoperatively diagnosed EGC underwent LADG at our department. We classified
these patients into two groups based on body mass index (BMI). There were 60 patients in the high-BMI (≥23 kg/m2) group and 56 in the low-BMI (<23 kg/m2) group. The clinicopathologic features, postoperative outcomes, and operationrelated morbidities were compared.
Results None of the patients needed conversion to laparotomy. There were no notable differences in clinical characteristics or histologic
features between the groups. Although the operation time was significantly longer in the high-BMI group, there were no significant
differences in postoperative bowel recovery, postoperative hospital stay, or operation-related morbidities.
Conclusions Laparoscopy-assisted distal gastrectomy for overweight patients is feasible and safe; however, because of its technical difficulties
and the complexities of lymph node dissection, it should be carefully considered, and may only be suitable for early-stage
cancers.
The content of this paper was presented at the 23rd Korean Gastric Cancer Congress Seoul, Korea, on April 13, 2007, and won
the best oral presentation session award. 相似文献
11.
Laparoscopic-assisted distal gastrectomy versus open distal gastrectomy for advanced gastric cancer 总被引:1,自引:0,他引:1
Background Laparoscopic-assisted gastric surgery has become an option for the treatment of early gastric cancer. However, there are few
reports of laparoscopic surgery in the management of advanced gastric cancer. In this study we describe our experience with
laparoscopic-assisted distal gastrectomy (LADG) for advanced gastric cancer (AGC).
Methods Between November 2004 and June 2007, 47 patients with AGC underwent LADG at our hospital, and 45 of those patients were enrolled
in this study. These patients were compared with 83 patients who had AGC and underwent conventional open distal gastrectomy
(ODG) during the same period.
Results Operation time was significantly longer in the LADG group than in the ODG group. Estimated blood loss in the LADG group was
significantly less than in the ODG group. Time to ambulation and first flatus and duration of analgesic medication were significantly
shorter in the LADG group. The morbidity and mortality rate were also lower than in the ODG group, with no statistically significant
difference. The distance of the proximal resection margin showed no significant difference compared with ODG (6.3 ± 0.9 versus
6.5 ± 0.9 cm; p = 0.228). The mean number of nodes resected with LADG was 35.6 ± 14.2, and that with ODG was 38.3 ± 11.4 (p = 0.269). The mean follow-up for the LADG group was 23.6 months (range 9–40 months). In the LADG group, recurrence was observed
in six patients (13.3%). Three patients had recurrence and died after 10 (IIIB), 11 (IIIA), and 13 (IIIB) months.
Conclusions LADG with extended lymphadenectomy for AGC is a feasible and safe procedure and has several advantages. Moreover, this method
can achieve a radical oncologic equivalent resection. Indications for LADG with extended lymphadenectomy could be expanded
in the treatment of locally advanced gastric cancer. 相似文献
12.
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. 相似文献
13.
腹腔镜辅助下远端胃癌根治术44例临床报告 总被引:5,自引:3,他引:5
目的探讨腹腔镜辅助下远端胃癌根治及D2淋巴结清扫术的手术可行性及效果. 方法 2004年3月~2005年5月行腹腔镜辅助下根治性远端胃切除术44例,除1例中转开腹外,行D1 α淋巴结清扫6例,D1 β清扫2例,D2/D2 清扫35例.毕Ⅰ式胃肠道重建14例,毕Ⅱ式27例,Roux-en-Y 3例. 结果 43例成功进行腹腔镜手术.1例因胃左动脉周围淋巴结融合而中转开腹手术.手术时间(282.8±32.8)min,出血量(139.3±82.7)ml,清扫淋巴结(30.1±17.0)枚,肿瘤近残端(6.0±1.3)cm,远残端(6.4±1.1)cm.术后肛门排气时间(4.1±0.8)d,下床活动时间(3.2±0.8)d.无术后死亡,无吻合口漏,术后并发症6例均经内科治疗痊愈或好转.术后随访1~15月,平均6.8月,1例Ⅳ期患者腹腔复发伴trocar穿刺道转移. 结论腹腔镜胃癌根治术较传统开腹手术耗时长,能达到胃癌标准根治术(D2)的淋巴结清扫范围,且具有创伤小、出血少、安全、术后恢复快等优点. 相似文献
14.
Satoh S Okabe H Kondo K Tanaka E Itami A Kawamura J Nomura A Nagayama S Watanabe G Sakai Y 《Surgical endoscopy》2009,23(2):436-437
Background Lymph node dissection is a crucial procedure for curative resection of gastric cancer [1]. To avoid portal vein injury during laparoscopic extended lymph node dissection for gastric cancer, taping of the common
hepatic artery and subsequent confirmation of the portal vein have been recommended [2, 3]. This taping method, however, makes laparoscopic nodal dissection technically complicated. This study introduces a novel
procedure for safe and simple laparoscopic suprapancreatic nodal dissection without taping of the common hepatic artery.
Methods The authors’ novel, simplified method consists of four steps: (1) dissection along the cranial edge of the pancreas from right
to left, (2) dissection along the splenic artery with exposure of the left renal fascia, (3) dissection along the left gastric
and the common hepatic arteries, and (4) retraction of the lymph nodes surrounding the common and proper hepatic arteries
and their complete dissection from the portal vein. This procedure is reversely directed compared with conventional open gastrectomy
(i.e., the nodal dissection is from left to right). For this study, the lymph node stations and groups were defined according
to the 13th edition of the Japanese Classification for Gastric Carcinoma. The described procedures were performed for 58 consecutive
patients with gastric cancer. The indication for this operation is primary T1/T2 gastric cancer without clinical nodal metastasis.
Results In all cases, safely extended suprapancreatic lymph node dissection was successfully accomplished using the described technique.
A total of 43.5 ± 18 lymph nodes were retrieved, including 14.4 ± 6.3 second-tier lymph nodes. The overall number of retrieved
lymph nodes in this study was similar to that reported previously [4]. Postoperative morbidity occurred at a rate of 22.3%, and the mortality rate was 0%. There was no conversion to open surgery.
The mean blood loss was 127 ml (range, 0–490 ml), and the mean operative time was 289 min (range, 104–416 min) in the last
20 consecutive cases. To date, no tumor recurrence has been observed. The median postoperative observation period was 1.4
years (range, 0.4–2.4 years).
Conclusion The described novel procedure would be sufficient and convenient for dissection of the suprapancreatic lymph nodes.
Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users. 相似文献
15.
【摘要】〓目的〓比较腹腔镜下全胃切除术与开腹全胃切除术分别联合D2淋巴结清扫治疗进展期胃癌的临床疗效。方法〓回顾性分析我院普外科228例行根治性全胃切除术联合D2淋巴结清扫治疗的进展期胃癌患者的临床病历资料,观察组行腹腔镜下全胃切除术联合D2淋巴结清扫术,对照组行开腹全胃切除术联合D2淋巴结清扫术,比较两组患者的近远期临床疗效。结果〓观察组手术时间显著长于对照组(P<0.001),而术中出血量明显少于对照组(P=0.004),两组术中淋巴结检出数目无显著差异(P>0.05)。观察组首次排气时间、胃肠道功能恢复时间及住院时间显著短于对照组(P均<0.05);两组肿瘤近远端切缘长度、住院费用比较,差异无统计学意义(P>0.05)。观察组术后并发症发生率7.89%,低于对照组的18.42%(P<0.05)。两组患者平均随访时间2.86±1.61年,两组患者1、3、5年无瘤生存率无显著性差异(P>0.05),观察组中位生存时间3.035(95%CI:2.683~3.386)年,对照组中位生存时间2.856(95%CI:2.669~3.044)年,两组患者总体生存时间无显著性差异(P>0.05)。结论〓腹腔镜下全胃切除联合D2淋巴结清扫术治疗进展期胃癌相比开腹全胃切除联合D2淋巴结清扫术而言,具有术后恢复快、并发症少、预后较好等优点,且术后远期生存率较高。 相似文献
16.
Laparoscopy-assisted distal gastrectomy for early gastric cancer in obese and nonobese patients 总被引:6,自引:0,他引:6
Background Conventional open gastrectomy has been reported to result in increased morbidity in obese patients. To date, there has been no study evaluating laparoscopic gastrectomy in such patients; therefore, we assessed the short-term results of this procedure in a group of obese patients.Methods The study included 99 consecutive patients who underwent laparoscopy-assisted distal gastrectomy (LDG) for the cure of early gastric cancer. The patients were divided into two groups: obese (body mass index [BMI] 25.0, n = 16) and nonobese (BMI <25.0, n = 83). Patient characteristics, operative details, and postoperative outcomes were compared and analyzed.Results Patient characteristics, including age, sex, American Society of Anesthesiologists (ASA) status, and disease stage, were not different between obese and nonobese patients. Operating time was significantly longer in obese patients than in nonobese patients (271 vs 239 min, p < 0.05). However, there was no significant difference between obese and nonobese patients in time to first flatus (3.7 vs 3.3 days), time to solid diet (6.3 vs 5.2 days), length of postoperative hospital stay (18.7 vs 17.9 days), or frequency of major (25% vs 16%) and minor (19% vs 12%) postoperative complications. There were no conversions to conventional open surgery and no perioperative deaths.Conclusion The only difference between our two study groups was that LDG required a longer operating time in obese patients; morbidity and length of hospital stay were not increased. Thus, we believe that LDG is likely to become the treatment of choice for obese patients with early gastric cancer. 相似文献
17.
Fujii H Aotake T Kawakami Y Okuda Y Doi K Hirose Y Matsushita T 《Surgical endoscopy》2008,22(12):2748-2752
The authors have used a modified hemi-double-stapling (HDS) technique for reconstruction after laparoscopically assisted distal
gastrectomy. The stomach is resected from the greater curvature side using a linear stapler inserted into the stomach from
that side at a position vertical to the line of the greater curvature. Resection of the stomach is performed by extending
the resection line to the lesser curvature using laparoscopic coagulating shears. The resected specimen is examined. After
placement of a purse-string suture at the duodenal stump, an anvil is inserted into the stump, and an additional suture with
2-0 silk is placed over the purse-string suture. A curved intraluminal stapler (CDH25) is inserted into the stomach through
the opening made on the lesser curvature side, and the center rod of the stapler is passed through the gastric wall on the
corner of the resection line at the greater curvature. Ligation with 2-0 silk is added to the center rod by suturing the gastric
tissue 5–8 mm from the center rod to encircle it. The authors call this the “one-knot setup HDS,” and with this method, a
large-caliber anastomosis is secured. In many cases, it is difficult to observe the anastomotic site through the small incisional
opening. However, under laparoscopy with the temporal abdominal wall-lift method using the Multi Flap Gate, the anastomotic
site can be easily and safely observed. One-knot setup HDS combined with the temporal abdominal wall-lift method is considered
a safe and simple method for performing Billroth I anastomosis in laparoscopic distal gastrectomy. 相似文献
18.
A total of 587 cases with gastric cancer was reviewed. Particular emphasis was placed on the comparative studies on the stages
of stomach cancer and end-results of the R2 (with a conventional lymph node dissection) and the R3-resections (with an extended lymph node dissection). R3-resections were found to be generally associated with higher 5-year survival rates than R2-resections. Especially for the positive lymph node cases not having a marked serosal invasion, the 5-year survival rate was
considerably higher with R3-resections than with R2-resections (55.3 percent versus 21.5 percent). Although the differences were not significant statistically, it has been suggested
from these results that the end-results might be improved more effectively by performing R3 resection for cases without a marked serosal invasion. 相似文献
19.
Prospective randomized study of open versus laparoscopy-assisted distal gastrectomy with extraperigastric lymph node dissection for early gastric cancer 总被引:10,自引:0,他引:10
Background Laparoscopy-assisted surgery with extraperigastric lymph node dissection for gastric cancers has been described, but the clinical
benefits of these surgeries still are unclear. Short-term clinical outcomes were compared between laparoscopy-assisted distal
gastrectomy (LADG) and conventional open distal gastrectomy (ODG) for early gastric cancer in a prospective randomized fashion.
Methods For this study, 28 patients with early gastric cancers in the lower half of the stomach were randomly assigned to either LADG
(n = 4) or ODG (n = 14). Postoperative pain, levels of acute inflammatory responses, and pathologic evaluation of the operative specimens were
compared.
Results The LADG group required a significantly shorter period of postoperative epidural anesthesia, showed significantly lower levels
of serum interleukin-6 and C-reactive protein, and had no major postsurgery complications. Pathologic examinations showed
that surgery was equally radical in the two groups.
Conclusion The findings show that LADG with extraperigastric lymph node dissection is a safe and less invasive alternative to the open
procedure.
This work was supported in part by the 21st Century COE (Center of Excellence) Programs Grant and a Grant-in-Aid for Scientific
Research (#15591377) from the Ministry of Education, Culture, Sports, Science and Technology of Japan. 相似文献
20.
目的:探讨围歼式D2淋巴结清扫在腹腔镜下远端胃癌根治术中的应用价值及临床效果。方法:回顾分析2009年12月至2011年12月为24例患者应用围歼式D2淋巴结清扫行腹腔镜辅助远端胃癌根治术的临床资料。淋巴结清扫过程不遵循沿肝总动脉清扫的原则,而是由外周正常组织开始清扫,逐渐显露不同的血管与分支。结果:本组24例手术均获成功,无一例中转开腹。术中出血量50~150 ml,平均(85±52)ml;淋巴结清扫数量12~32枚,平均(21±11)枚;淋巴结转移数量0~13枚,平均(7±4)枚;手术时间120~286 min,平均(186±50)min;首次术后排气时间平均(2.3±0.5)d,首次术后下地时间平均(1.2±0.6)d;切口长度平均(5.6±1.6)cm;平均住院(10.5±2.5)d。术后并发轻度高碳酸血症及淋巴漏各1例,均经治疗后痊愈。结论:腹腔镜下远端胃癌根治术中行围歼式D2淋巴结清扫是可行的,其清扫方法更符合肿瘤根治原则,且具有患者创伤小、康复快等优点。 相似文献