共查询到20条相似文献,搜索用时 78 毫秒
1.
腹腔镜辅助胃癌根治术105例 总被引:89,自引:2,他引:89
目的探讨腹腔镜辅助胃癌根治术的安全性及可行性。方法对105例胃恶性肿瘤患者行腹腔镜辅助根治性胃切除术,其中根治性全胃切除术7例,近端胃大部切除术27例,近端胃大部联合脾脏切除术3例,远端胃大部切除术68例。结果 105例手术均获成功。手术时间:全胃切除术300~435min,平均(38l±91)min;近端胃切除术212~390 min,平均(279±73)min;近端胃切除联合脾脏切除术265~405 min,平均(312±64)min;远端胃切除术230~360 min,平均(281±69)min。术中出血量:全胃切除术20~900 ml,平均(260±202)ml;近端胃切除术20~400 ml,平均(200±153)ml;近端胃联合脾脏切除术200~400 ml,平均(333±116)ml;远端胃切除术20~450 ml,平均(140±82)ml。平均清扫淋巴结(34.2±20.5)枚。术后胃肠功能恢复时间平均(3.5±1.4)d,下床活动时间平均(3.0±1.6)d,进流食时间平均(4.9±1.7)d。术后近期效果良好。结论腹腔镜辅助胃癌根治术安全可行,且具有创伤小、术后恢复快等优点。 相似文献
2.
目的探讨腹腔镜对进展期胃癌手术治疗的安全性、可行性及疗效。方法回顾性分析大连医科大学附属二院普外科2011年5月-2014年1月120例进展期胃癌患者的临床资料,其中59例患者行腹腔镜辅助下胃癌根治术治疗,61例患者行传统开腹胃癌根治术。结果腹腔镜组均成功完成胃癌根治术,无中转开腹。与开腹组相比,术中出血量更少,术后胃肠道功能恢复更快。结论腹腔镜辅助下胃癌根治术安全、可行,与开腹组治疗效果相同,且腹腔镜组因创伤小术后恢复快,值得推广。 相似文献
3.
坚持手术的安全性和肿瘤的根治性是腹腔镜胃癌根治术的第一准则。在腹腔镜胃癌根治术不断规范、推广和普及的当今,重视手术的安全性,降低并发症的发生率,避免严重手术并发症的发牛,是胃肠外科医师们所追寻的目标。腹腔镜胃癌根治术常见的腹部并发症包括腹腔内出血、吻合口瘘、吻合口狭窄、脏器损伤、胰漏等。本文主要探讨腹岁腔镜胃癌根治术常见腹部并发症的原因及其预防。 相似文献
4.
5.
腹腔镜辅助远端胃癌根治术 总被引:1,自引:0,他引:1
腹腔镜辅助远端胃癌根治术(LADG)是微创外科的技术之一,是现代外科的重要发展方向之一。按照日本胃癌治疗指南.LADG的适应证应严格限定在早期胃癌中,进展期胃癌应属于探索性临床研究。LADG在早期胃癌病例中应用的短期优势已得到较普遍地认可,但全腹腔镜技术尚需进一步研究探索;而LADG在进展期胃癌中的应用仍然是目前学术争议的热点之一。虽然当前有研究显示,LADG加D2淋巴结清扫对于进展期胃癌其效果与开腹手术相当,但仍需等待中国、日本和韩国目前正在进行的大样本多中心随机对照试验的结果确认。 相似文献
6.
腹腔镜辅助下早期远端胃癌根治术七例 总被引:1,自引:0,他引:1
目的 探讨腹腔镜辅助下行早期远端胃癌根治的手术方法和手术适应证。方法 对7例早期胃癌患者行腹腔镜辅助下胃癌根治术的临床资料进行回顾性分析。结果 7例患者均顺利完成手术,无中转开腹。手术时间平均190min;术中出血量平均150ml;术后排气时间平均51h,均于术后6—9d出院。无手术及术后并发症。术后随访平均10个月,未见肿瘤复发迹象。结论 腹腔镜辅助下早期远端胃癌根治安全、可行,近期效果满意。 相似文献
7.
腹腔镜辅助胃癌根治术16例分析 总被引:1,自引:0,他引:1
1994年日本学者Kitano等[1]首次报道腹腔镜胃癌根治术治疗早期胃癌,此后应用逐渐广泛。由于腹腔镜胃癌根治手术难度高、风险大、操作复杂、技术要求高,国内至今仍限于大型医院开展。我院2007年3月—2009年12月完成腹腔镜下胃癌D2根治术16例,总结报道如下。 相似文献
8.
治疗胃癌的腹腔镜胃切除手术(laparoscopic gastrectomy,LG)在过去的20年中运用范围日益广泛。相关的循证医学结果显示,在近期疗效方面,LG 已达到不低于开腹胃切除手术(open gastrectomy,OG)的肿瘤临床治疗效果,且具有微创等优势。在远期疗效方面,LG 与 OG 治疗早期胃癌相近的疗效已获得了充足的循证医学证据,LG 已成为早期胃癌可选的标准治疗方法之一。虽然不少研究显示 LG 治疗进展期胃癌亦能取得 OG 同样的远期疗效,但仍缺乏多中心的前瞻性随机对照研究结果来评价腹腔镜手术的优劣。外科医师只有严格选择合适病例,手术中严格遵循恶性肿瘤手术的根治原则,才能使腹腔镜胃癌根治术在取得微创优势的基础上具有与开腹手术相当的疗效。 相似文献
9.
完全腹腔镜与腹腔镜辅助胃癌根治术的比较 总被引:3,自引:0,他引:3
目的 研究缝合重建完全腹腔镜下胃癌根治术与腹腔镜辅助下胃癌根治术的优缺点,探讨在完全腹腔镜下缝合重建吻合方式的安全性与可行性.方法 回顾性分析2009年7月至2010年7月在第四军医大学西京消化病医院完全腹腔镜下缝合重建胃癌D2根治术与腹腔镜辅助胃癌D2根治术49例患者的临床资料,手术均由同一位经验丰富的普通外科医师完成.结果 完全腹腔镜胃癌根治21例中行远端胃切除15例,全胃切除6例,均采用镜下手工缝合胃肠吻合和空肠-空肠吻合,应用25mm管型吻合器完成食管空肠吻合;腹腔镜辅助胃癌根治28例中行远端胃切除21例,全胃切除7例.完全腹腔镜组与腹腔镜辅助组平均手术时间分别为(279±65)min、(232±40)min(P<0.05),平均肿瘤下切缘为(3.1±0.9)cm、(2.9±0.9)cm(P>0.05),平均上切缘为(5.7±1.5)cm、(5.1±1.4)cm(P>0.05),两组切缘均无癌残留.完全腹腔镜组术后无需用镇痛药,腹腔镜辅助组平均使用镇痛药1.8 d;完全腹腔镜组术后通气时间为3 d,腹腔镜辅助组为4.8 d;完全腹腔镜组术后发生早期并发症2例,其中1例腹腔感染,1例肺部感染.腹腔镜辅助组2例,其中1例切口感染,1例肺部感染.术后中位随访时间4个月,两组均无吻合口瘘与狭窄发生.结论 完全腹腔镜下缝合重建的胃癌D2根治术具有可以接受的手术时间和早期并发症的发生率,可在有选择的患者中由经验丰富的外科医师应用.Abstract: Objectives To compare total laparoscopic gastrectomy with intracorporeal hand-sewn Gl reconstruction and laparoscopy-assisted gastrectomy for gastric cancer. Methods Between July 2009 and July 2010, 21 patients of gastric cancer underwent total laparoscopic D2 radical gastrectomy with intracorporeal hand-sewn reconstruction and 28 did laparoscopy-assisted D2 radical gastrectomy in Xijing Hospital of Digestive Diseases. All patients were operated on by an experienced surgeon. Patient demographics, TNM stage, location of tumor, the intraoperative and postoperative details of the two groups were compared. Results In the 21 patients undergoing total laparoscopic gastrectomy, there were 15 of distal gastrectomy and 6 of total gastrectomy, compared with 21 and 7 in laparoscopy-assisted group. In total laparoscopic group, intracorporeal hand-sewn technique was used for gastro-jejunal and jejuno-jejunal (J-J)anastomosis, and 25 mm circular stapler was used for esophago-jejunal anastomosis. The operation time was significant longer in total laparoscopic group than in laparoscopy-assisted group of (279 ± 65 ) min vs.(232 ±40) min (P < 0.05 ). No significant difference was observed between the two groups in proximal margin [(5.7 ± 1.5 )cm vs. (5.1 ± 1.4) cm, P > 0.05] and distal margin [( 3.1 ± 0.9 )cm vs. ( 2.9 ±0.9) cm,P >0.05]. The iv narcotic use in laparoscopy-assisted group was 1.8 d but it was not used in total laparoscopic group. The first passing flatus was on day 3 in total laparoscopic group compared with 4.8 d in laparoscopy-assisted group. Both groups had 2 postoperative early complications, one intra-abdominal infection and one lung infection in total laparoscopic group compared with one wound infection and one lung infection in laparoscopy-assisted group. There was no anastomosis-related complications after 4 months of follow-up. Conclusions The operation time and postoperative early complication was acceptable for selected patients treated by total laparoscopic D2 radical gastrectomy with intracorporeal hand-sewn GI tract reconstruction in hands of experienced laparoscopic surgeon. 相似文献
10.
11.
Teruo Kiyama Itsuo Fujita Hitoshi Kanno Aya Tani Toshiro Yoshiyuki Shunji Kato Takashi Tajiri Adrian Barbul 《Journal of gastrointestinal surgery》2008,12(10):1807-1811
Objective The purpose of this study was to evaluate the safety and value of laparoscopy-assisted distal gastrectomy (LADG) for early
stage gastric cancer (stages IA, IB, and II).
Materials and Methods We retrospectively assessed 101 cases treated by LADG and compared to 49 contemporaneous cases treated by open distal gastrectomy
(DG) between 2001 and 2006. Clinical variables, such as tumor diameter, operation time, blood loss, number of lymph nodes
dissected, and length of stay were investigated.
Results Tumor size (mm) was significantly smaller in the LADG group (p < 0.0001). Although operation time (min) in the two groups was similar (278 ± 57 vs. 268 ± 55), mean blood loss was significantly
higher in the DG group (139 ± 181 vs. 460 ± 301, p < 0.0001). Fewer lymph nodes were harvested in the LADG group (27 ± 14 vs. 34 ± 19, p = 0.012). Hospital stay was longer in the DG group (13.3 ± 8.5 vs. 16.7 ± 10.5, p = 0.034). There was no mortality in either group. Postoperative surgical complications occurred in six (6%) of the LADG and
four (8%) of the DG.
Conclusions The authors conclude that laparoscopy-assisted distal gastrectomy is a safe and useful operation for early-stage gastric cancers.
If patients are selected properly, laparoscopy-assisted distal gastrectomy can be a curative and minimally invasive treatment
for gastric cancer.
Presented at The Forty-Eighth Annual Meeting of The Society for Surgery of the Alimentary Tract, Washington DC, May 19–24,
2007. 相似文献
12.
Tetsu Fukunaga MD PhD Naoki Hiki MD PhD Takeshi Kubota MD PhD Souya Nunobe MD PhD Masanori Tokunaga MD Kyoko Nohara MD Takeshi Sano MD PhD Toshiharu Yamaguchi MD PhD 《Annals of surgical oncology》2013,20(8):2676-2682
Background
In both advanced and early gastric cancer with preoperatively suspected lymph node metastasis, extended lymph node dissection is needed to achieve R0. Since extended lymph node dissection is difficult to perform laparoscopically, few reports have reported long-term outcomes in large numbers of patients. The purpose of this study was to investigate oncologic outcomes after laparoscopy-assisted distal gastrectomy (LADG) with extended lymph node dissection.Methods
Between April 2004 and March 2010, LADG with extended lymph node dissection was performed at our hospital for 880 patients diagnosed with T1N0-1 or T2N0 (N is classified by Japanese topographic classification) gastric cancer in the lower or middle body of the stomach. D2 lymph node dissection was performed for stage IB (T1N1, T2N0) cancers. Modified D2 lymph node dissection was performed for stage IA (T1N0). Overall survival (OS), disease-free survival (DFS), and form of tumor recurrence at 4 years were investigated retrospectively.Results
Median follow-up was 42 months. The 4-year OS was 98.2 % for all patients. By stage, OS/DFS were 99.0/99.0 % in stage IA patients, 95.9/95.9 % in stage IB, 92.6/92.0 % in stage IIA, and 90.0/92.9 % in stage IIB. A total of 11 patients died, including 4 deaths from recurrence (liver metastasis, n = 1; peritoneal dissemination, n = 2; distant lymph node and bone metastases, n = 1). There is 1 patient is alive with recurrence (liver). Mean time until recurrence was 14 months.Conclusions
Oncologic outcomes were good in patients with T1N0-1 and T2N0 gastric cancer who underwent LADG with extended lymph node dissection. This approach appears effective for treating T1N0-1 and T2N0 gastric cancer. 相似文献13.
14.
Seigo Kitano Tsuyoshi Etoh Masafumi Inomata Norio Shiraishi 《Annals of surgical oncology》2011,18(13):3701-3701
Background
Laparoscopic gastrectomy with lymph node dissection, such as laparoscopy-assisted distal gastrectomy (LADG), has been widely accepted as the treatment for early gastric cancer with the risk of lymph node metastasis, especially in Asia since 1991.1 – 3 相似文献15.
Hideki Kawamura Norihiko Takahashi Shigenori Homma Nozomi Minagawa Susumu Shibasaki Masahiro Takahashi Akinobu Taketomi 《International surgery》2014,99(5):645-649
Laparoscopic gastrectomy has the advantage of early recovery at the initial phase after surgery. However, there are only few reports of mid- or long-term observations of patients'' quality of life. In all, 254 Stage IA or IB [laparoscopy-assisted distal gastrectomy (LADG): 177, open distal gastrectomy (ODG): 77] patients were enrolled. Heart burn, diarrhea, abdominal pain, amount of food intake, and body weight of each patient were investigated at 1 month, 3 months, 6 months, and 1 year after surgery. Recovery of the amount of oral intake for the LADG group occurred earlier than for the ODG group; significant differences were seen at months 1 and 6 postoperatively. A significantly lower incidence of diarrhea was observed in the LADG group at months 6 and 12 postoperatively. Early recovery of the amount of food intake and fewer incidences of diarrhea were shown to have mid-term merits for postgastrectomy symptoms.Key words: Laparoscopy, Gastrectomy, Gastric cancer, Postoperative symptomsLaparoscopic gastrectomy is well known as a less invasive surgery, which provides an early recovery from the pain, bowel paralysis, and hematologic parameters. However, these well-examined objects belong to the recovery by the day.1−3 On the other hand, the fluctuation of the frequency of heart burn, diarrhea and abdominal pain after eating, amount of oral intake, and body weight loss persist for months. So these subjects belong to the recovery by the month. And only a few studies about these subjects after laparoscopic gastrectomy compared with open gastrectomy.4,5 Therefore, it is unclear whether laparoscopic gastrectomy has merits for improved mid- or long-term quality of life (QOL). In this study, we observed these postgastrectomy symptoms during the first year after surgery, and compared the changeover between laparoscopy-assisted distal gastrectomy (LADG) and open distal gastrectomy (ODG). 相似文献
16.
Hirohito Fujikawa Takaki Yoshikawa Toru Aoyama Tsutomu Hayashi Haruhiko Cho Takashi Ogata Jyunya Shirai Takashi Oshima Norio Yukawa Yasushi Rino Munetaka Masuda Akira Tsuburaya 《International surgery》2013,98(3):266-270
Situs inversus totalis (SIT) is a congenital condition in which there is complete right to left reversal of the thoracic and abdominal organs. This report describes laparoscopy-assisted distal gastrectomy (LADG) for an early gastric cancer patient with SIT. The preoperative diagnosis was c-stage IA (cT1a cN0 cH0 cP0 cM0). LADG with D1+ dissection and Billroth-I reconstruction was successfully performed by standing at the opposite position. The operating time was 234 minutes and blood loss was 5 mL. Although a mechanical obstruction occurred after surgery, the patient recovered after re-operation with Roux-en-Y bypass. 相似文献
17.
18.
Wei Wang Kai-Xing Ai Feng Tao Ke-Tao Jin Yuan-Ming Jing Guan-Gen Xu Jie-Qing Lv Ting Wang Jian-Guo Wei Ai-Jing Sun Hai-Yan Xing 《Journal of gastrointestinal surgery》2016,20(6):1091-1097
Background
Laparoscopy-assisted distal gastrectomy (LADG) has been widely accepted for the treatment for gastric cancer. The aim of the present study was to explore the impact of abdominal shape parameters on gastric antrum cancer patients’ short-term surgical outcomes of LADG with D2 lymph node dissection in both genders, including the number of lymph nodes retrieved and surgical safety index.Methods
This was a retrospective analysis of 177 gastric antrum cancer patients, who underwent LADG between April 2009 and January 2016. The abdominal shape parameters, including abdominal anterior-posterior diameter (APD), transverse diameter (TD), xiphoid process of the sternum-navel distance (XND), and thickness of subcutaneous fat (SCF) at the umbilicus level, were calculated by preoperative abdominal computed tomography (CT) scans. The effects of abdominal shape parameters on the short-term surgical outcomes of LADG were analyzed.Results
In male patients undergoing LADG and D2 lymph node dissection, the number of retrieved lymph nodes was significantly lower in patients with APD ≥17.3 cm (P?=?0.005), TD ≥27.4 cm (P?=?0.029), SCF ≥1.2 cm (P?=?0.014), and BMI ≥22.2 (P?=?0.008), whereas in female patients, these were statistically insignificant (P?>?0.05). APD, TD, SCF, and BMI were negatively correlated with the number of retrieved lymph nodes in male patients. There was no significant difference in the number of lymph nodes retrieved between high-XND group and low-XND group in either gender. Operation time was significantly shorter in male patients with XND?<?17.0 cm (P?=?0.044) and in female patients with SCF?<?2.15 cm (P?=?0.013). Intraoperative blood loss and postoperative complication rate were not significantly different between high- and low-APD groups, high- and low-TD groups, high- and low-XND groups, and high- and low-SCF groups in either gender. Compared with male patients, SCF and TD were significantly higher in female patients. In addition, a higher incidence rate of hypertension was observed in patients of both genders with large APD and SCF, although statistically significant only in male patients.Conclusions
LADG with D2 lymph node dissection can effectively achieve the lymph node dissection requirement of radical distal gastrectomy for patients with various abdominal shapes. It is worth noting that APD, TD, and SCF can impact on lymph node dissection of LADG in male patients. Nevertheless, in female patients, abdominal shape do not impact on lymph node dissection of LADG. Moreover, LADG with D2 lymph node dissection is proved to be safe for various abdominal shape in both genders, even for abdominal obese patients.19.
Tzung-Hsin Chou Ming-Hsun Wu Ming-Yang Wang Ching-Yao Yang Peng-Sheng Lai Ming-Tsan Lin Po-Huang Lee 《Journal of gastrointestinal surgery》2008,12(4):695-700
Background Due to the highly invasive nature of traditional surgery and the limitation of gas-filling laparoscopic surgery in gastric
cancers, we developed a new method of gasless laparoscope-assisted subtotal gastrectomy (GLASG). This study investigated the
technique and clinical results of this procedure and compared it with traditional radical subtotal gastrectomy (TRSG) for
early gastric cancers.
Methodology From December 2004 to January 2006, 41 patients diagnosed with early gastric cancer were included in the study. All cases
underwent subtotal gastrectomy with standard radical lymph node dissection. Twenty patients underwent GLASG, whereas the other
21 patients underwent TRSG. In the GLASG group, we performed our newly developed method using three working ports created
at the bilateral subcostal and umbilicus, which provided a 3-dimensional sensation by direct vision through a minilaparotomy
and laparoscopic view simultaneously. B-II gastrojejunostomy reconstruction was performed by intracorporeal anastomosis using
an endostapler. The TRSG group underwent the standard open method used for gastric cancer. Preoperative characteristics and
postoperative recovery between the two groups were compared.
Results The operative time was comparable between the two groups, but the bleeding was significantly less severe in the GLASG group.
Postoperative pain was significantly less in the GLASG group, as well as body temperature from postoperative day 2 to 7. The
number of days to first flatus, first oral intake, and discharge were all significantly less in the GLASG group. No major
complications were noted in either group.
Conclusions GLASG may be a feasible and safe procedure for early gastric cancer. Gasless laparoscopic gastrectomy has the advantages of
less pain, better cosmetic outcome, and earlier recovery. The newly developed gasless environment may hybridize the advantages
of open method and pure laparoscopic method.
This paper was invited to be presented at International Society of Digestive Surgery, Roma, Dec. 1st, 2006. 相似文献
20.
Jin chen Hu Li xin Jiang Li Cai Hai tao Zheng San yuan Hu Hong bing Chen Guo chang Wu Yi fei Zhang Zhong chuan Lv 《Journal of gastrointestinal surgery》2012,16(10):1830-1839