腹腔镜辅助胃癌根治术淋巴结清扫效果的临床对照研究

目的 探讨腹腔镜辅助胃癌根治术中淋巴结清扫的可行性及临床效果.方法 2007年1月至2010年5月,对934例胃癌患者施行根治性手术(RO切除),其中行腹腔镜手术患者(腹腔镜组)506例,行开腹手术患者(开腹组)428例.对比两组患者淋巴结清扫数目的 差异,并分析两组淋巴结清扫数目与术后并发症发生率的关系.结果 全部患者平均淋巴结清扫数目为(29±10)枚/例,两组平均淋巴结清扫数目相似(P＞0.05),但腹腔镜组No.7、8组淋巴结清扫数目明显多于开腹组(P＜0.05).按浸润深度分层分析,除pT3期腹腔镜组平均淋巴结清扫数目多于开腹组外,pT1-2期差异无统计学意义(P＞0.05);按淋巴结清扫范围和胃切除方式分层分析,腹腔镜组平均淋巴结清扫数目均与开腹组相当(P＞0.05);按手术时期分层分析,≤50例腹腔镜组平均淋巴结清扫数目少于开腹组(P＜0.05),51～100例和≥101例则与开腹组相当(P＞0.05).腹腔镜组并发症发生率为11.1%,明显低于开腹组的20.1%,但两组淋巴结清扫数目与术后并发症的相关性均无统计学意义(P＞0.05).结论 随着腹腔镜外科医师技术逐渐成熟,腹腔镜胃癌根治手术能够达到与开腹手术相当的淋巴结清扫效果;合理增加腹腔镜辅助胃癌根治术的淋巴结清扫数目不会增加术后并发症发生率.

Abstract：

Objective To explore the feasibility and efficacy of laparoscopy assisted radical gastrectomy on lymph node(LN)dissection for gastric cancer and to compare it with open gastrectomy.Methods The clinical data of 934 patients with gastric cancer underwent radical resection from January 2007 to May 2010 were analyzed retrospectively. Among the patients, 506 cases received laparoscopy assisted gastrectomy(LAG group)and 428 cases received open gastrectomy(OG group). The number of retrieved LNs and the survival curve between the two groups was compared. Then, the relations between the number of dissected LNs and postoperative morbidity were analyzed. ResultsFor all patients, the mean number of dissected LNs was 29±10, there was no significantly differences between LAG group and OG group(P＜0.05). While the number of the retrieved No. 7, 8 LNs in LAG group were significantly more than those in OG group. No significant differences was found in the number of dissected LNs for the pT1-2stages tumors between the two groups, but significantly greater number of LNs was harvested by LAG group in pT3 stage(P＜0. 05). No significant differences were found in the number of dissected LNs in different gastrectomy types or extents of LN dissection between the two groups. In the first 50 cases, there were less dissected LNs in LAG group than that in OG group, while 51 cases later, there was no significantly differences in number of dissected LNS between the two groups(P＞0.05). The postoperative morbidity of LAG group and OG group was 11.1% and 20. 1%, respectively(P ＜0.05), but there was no significant correlations between the number of dissected LNs and postoperative morbidity in both groups. Conclusions With the improvement in surgical skills, laparoscopy-assisted radical gastrectomy with lymph node dissection is a safe and feasible procedure, and it is oncologically compatible with open gastrectomy. Suitable increment of dissected LN count would not increase the postoperative complication rate.     

腹腔镜胃癌根治术726例的疗效分析

目的 探讨腹腔镜胃癌根治术的临床疗效.方法 回顾性分析2004年1月至2010年4月第三军医大学西南医院收治的726例行腹腔镜胃癌根治术患者的临床资料.分析本组患者手术时间、术中出血量、淋巴结清扫数目、住院时间、并发症发生率等各项指标.计量资料采用t检验,计数资料采用x2检验,生存分析采用Kaplan-Meier法.结果 726例患者中707例成功实施腹腔镜胃癌根治术,19例中转开腹.平均手术时间为(179±52)min,术中平均出血量为(87±51)ml,平均淋巴结清扫数目为(33±14)枚,手术切除标本近、远切缘距肿瘤边缘距离分别为(6.3±1.9)cm和(5.6±1.7)cm.术后平均肛门排气时间为(2.9±1.4)d,术后平均进流质饮食时间为(3.1±1.7)d,术后平均住院时间为(7.9±3.5)d,术中并发症发生率为2.2%(16/726);术后并发症发生率为4.0%(29/726).随访时间6～82个月,平均48.3个月,患者5年总体生存率为58.4%.结论 腹腔镜胃癌根治术具有创伤小,并发症少,术后恢复快等优点,临床疗效较满意.

Abstract：

Objective To explore the efficacy of laparoscopy-assisted radical gastrectomy for patients with gastric cancer. Methods The clinical data of 726 patients who received laparoscopy-assisted radical gastrectomy for gastric cancer at the Southwest Hospital from January 2004 to April 2010 were retrospectively analyzed. The operation time, operative blood loss, number of lymph nodes dissected, length of hospital stay and mobidity were evaluated using t test or chi-square test. The survival of the patients were evaluated by Kaplan-Meier method.Results Laparoscopy-assisted radical gastrectomy was successfully carried out on 707 patients, and 19 patients were converted to open surgery. The mean operation time, operative blood loss, number of lymph nodes dissected were (179 ±52)minutes, (87 ±51) ml and 33 ± 14, respectively. The average distances of proximal and distal resection margin to the tumors were (6.3 ± 1.9)cm and (5.6 ± 1.7)cm, respectively. The average time to flatus, time to fluid diet and length of hospital stay were (2.9 ± 1.4) days, (3.1 ± 1.7) days and (7.9 ± 3.5) days,respectively. The peri- and postoperative mobidities were 2.2% (16/726) and 4.0% (29/726), respectively. A total of 685 patients were followed up for 6-82 months (mean, 48.3 months), and the 5-year survival rate was 58.4%. Conclusions Laparoscopy-assisted radical gastrectomy is a feasible procedure with minimal trauma, low morbidity and quick recovery of patients.     

完全腹腔镜与腹腔镜辅助Roux-en-Y吻合在远端胃癌根治术中的应用

目的探讨完全腹腔镜下Roux-en-Y吻合技术在远端胃癌根治术的安全性及可行性。方法回顾性分析2014年5月至2015年6月150例远端胃癌根治术Roux-en-Y吻合病人的临床资料,其中78例行完全腹腔镜胃癌根治术(total laparoscopic gastrectomy,TLG)和72例行腹腔镜辅助下胃癌根治术(laparoscopy-assisted gastrectomy,LAG)。结果 150例手术均获成功,术后病理检查切缘均为阴性。TLG组平均手术时间为(261.4±30.9)min,与LAG组的(258.1±26.7)min相比,差异无统计学意义(P0.05)。TLG组切除淋巴结为(32.4±9.2)枚,与LAG组切除淋巴结(33.5±9.4)枚相比,差异无统计学意义(P0.05)。但TLG组术中出血量明显少于LAG组[(270.7±63.4)ml比(372.9±84.6)ml,P0.05],手术切口长度明显短于LAG组[(3.1±0.8)cm比(7.3±1.6)cm,P0.05],差异均有统计学意义。同时,TLG组术后镇痛天数、住院时间、首次下床活动时间、首次进食流质时间、术后肛门排气时间均较LAG组显著缩短,差异有统计学意义(均P0.05)。术后随访6个月,LAG组吻合口相关并发症发生率为4.2%(3/72),TLG组均未出现吻合口漏、吻合口狭窄、吻合口出血、十二指肠残端瘘或肠梗阻等相关并发症。结论完全腹腔镜下远端胃癌根治术Roux-en-Y吻合技术是安全、可行的,与小切口腹腔镜辅助吻合相比具有创伤小、出血少、恢复快、住院时间短及疼痛感轻等优势,近期效果显著。     

腹腔镜辅助与开腹胃癌根治术围手术期疗效的对比研究

目的:对比分析腹腔镜辅助胃癌根治术与开腹胃癌根治术的术后早期疗效.方法:回顾分析2005年至2010年为21例患者行腹腔镜辅助胃癌根治术的临床资料(腹腔镜组,laparoscopic gastrectomy,LG组),以同期66例开腹胃癌根治术作为对照(开腹组,open gastrectomy,OG组);对比两组患者的...     

腹腔镜D2根治术治疗无浆膜层侵犯的进展期胃癌129例

目的：评价腹腔镜胃癌D2根治术治疗无浆膜层侵犯的进展期胃癌的可行性、安全性及疗效。方法：129例无浆膜层侵犯的进展期胃癌患者中,32例（24.8%）行完全腹腔镜远端胃切除术（total laparoscopic distal gastretomy,TLDG）,43例（33.3%）行腹腔镜辅助全胃切除术(laparoscopic-assisted total gastrectomy,LATG),54例（41.9%）行腹腔镜辅助远端胃切除术(laparoscopic-assisted distal gastrectomy,LADG)。结果：本组129例手术均获成功,手术时间为(196±35.5) mins,术中出血量(150±40) mL,术后肠功能恢复时间为(2.7±0.7) d,淋巴结清扫数平均(26±4)枚;术后随访13~70个月,15例有局部复发或远处转移,死亡4例。结论：腹腔镜胃癌D2根治术治疗无浆膜层侵犯的进展期胃癌安全、可行,具有创伤轻、恢复快等优点,有着较好的近远期疗效。     

腹腔镜手助与辅助技术在右半结肠切除术中应用的对比研究

目的 比较腹腔镜手助与辅助技术在右半结肠癌根治术中的应用效果.方法 回顾性分析北京协和医院基本外科同一组医师2002年3月至2006年11月采用腹腔镜手助技术(HALS组,47例)和2007年1月至2009年12月采用腹腔镜辅助技术(LAS组,48例)完成的右半结肠癌根治术患者的临床资料.对比其手术安全性、术后恢复情况和并发症、肿瘤根治性、医疗费用和随访结果.结果 HALS组和LAS组术中、术后均无严重并发症和死亡病例.HALS组与LAS组相比,术中出血(P<0.01)、手术时间(P<0.05)和切口长度(P<0.05)差异均有统计学意义;但中转开腹、术中副损伤术后肛门排气时间、下床时间、住院天数、进食时间、术后镇痛例数方面的差异均无统计学意义(均P>0.05).HALS组手术切除标本长度为(25.6±9.9)cm,与LAS组的(26.8±7.9)cm比较,差异无统计学意义(P>0.05):HALS组淋巴结清扫总数为(18.2±12.1)枚,与LAS组的(24.1±9.3)枚比较,差异有统计学意义(P<0.05).LAS组的医疗费用(28 049.8±7576.1)元,多于HAKS组的(21 132.7±5323.4)元(P<0.05).HALS组和LAS组3年生存率分别为91.3%和87.9%,差异无统计学意义(P=0.452).结论 腹腔镜手助和辅助技术在右半结肠切除术中可获得相同的微创效果和肿瘤学疗效.

Abstract：

Objective To compare the outcomes of right hemicolectomy performed either by the hand-assisted laparoscopic (HALS) or conventional laparoscopic surgery (LAS). Methods Ninety-five patients undergoing HALS(n=47) from March 2002 to November 2006 or by LAS (n=48) from January 2007 to December 2009 were retrospectively studied. All the operations were performed by the same surgical team. Patient safety, postoperative recovery, complications, oncologic outcomes, medical expenses, and the follow-up results were compared between the two groups. Results No severe complications or perioperative deaths were oberved. There were significant differences between the two groups in terms of intraoperative bleeding, operative time, and length of incision (all P<0.05). However, the conversion rate, intraoperative injuries, time to first bowel movement, postoperative bedrest time, hospital stay, time to first oral intake, and the number of patients requiring postoperative analgesia were comparable between the two groups (P>0.05). Length of surgical specimen was (25.6±9.9) cm in the HALS group and was (26.8±7.9) cm in the LAS group, the diffenence was not statistically significant (P<0.05).The mean number of lymph nodes retrieved in HALS group was 18.2± 12.1, which was significantly lower than that in LAS group (24.1 ±9.3, P<0.05). The medical expense of the LAS group was (28 049.8±7576.1) RMB, which was significantly higher than that of the HALS group (21 132.7±5323.4) RMB (P<0.05). A follow-up rate of 93.7% was achieved in the HALS group with 3 patients lost to follow-up. The follow-up duration ranged from 45.4 to 101.9 months with a median of 66.7 months. In LAS group, the follow-up rate was 96% with 2 patients lost to follow-up and the follow-up duration ranged from 12.4 to 45.7 months with a median of 21.6 months. There was no significant difference in 3-year disease-free survival (91.3% vs. 87.9%, P> 0.05) between the two groups. Conclusion HALS and LAS can achieve similar minimal invasiveness efficacy and oncologic outcomes for right hemicolectomy.     

腹腔镜结直肠癌根治术疗效分析

Objective To investigate the efficacy of laparoscopic radical resection for colorectal cancer. Methods From September 2000 to December 2004, 99 patients with colorectal cancer underwent laparoscopic radical resection (laparoscopic group) and 198 patients with colorectal cancer underwent open radical resection (open group) at the Union Hospital of Fujian Medical University. The differences in local recurrence and survival between the two groups were compared. The local recurrence of tumors and survival of patients in the two groups were calculated by the life-table method, and were compared by the Wilcoxon (Gehan) test, chi-square test and Fisher's exact test. The recurrence interval and survival time of the two groups were compared by non-parametric Wilcoxon rank sum test. Results The 2-and 3-year local recurrence rates in the laparoscopic group were both 3.0% and the overall local recurrence rate was 3.0% (3/99). The 2-and 3-year local recurrence rates in the open group were 2.6% and 4.0% , respectively, and the overall local recurrence rate was 3.5% (7/198), with no significant difference between the two groups (χ2 =0.002, P > 0. 05). The median survival time of patients with local recurrence was 15 months (range, 7-24 months) in the laparoscopic group and 11 months (range, 2-28 months) in the open group, with no significant difference between the groups (U = 15. 500, P >0. 05). The 1-year survival rate was 33.3% in the laparoscopic group and 42.9% in the open group. The 2-year survival rate was zero in the laparoscopic group and 42. 9% in the open group. There were no significant differences between the groups for the 1-and 2-year survival rates (χ2 =0.120, P>0.05). Conclusions The efficacy of laparoscopic radical resection for colorectal cancer is similar to that of open surgery. Laparoscopic radical resection for colorectal cancer is safe and feasible, and does not increase the recurrence rate of cancer.     

腹腔镜结直肠癌根治术疗效分析

Objective To investigate the efficacy of laparoscopic radical resection for colorectal cancer. Methods From September 2000 to December 2004, 99 patients with colorectal cancer underwent laparoscopic radical resection (laparoscopic group) and 198 patients with colorectal cancer underwent open radical resection (open group) at the Union Hospital of Fujian Medical University. The differences in local recurrence and survival between the two groups were compared. The local recurrence of tumors and survival of patients in the two groups were calculated by the life-table method, and were compared by the Wilcoxon (Gehan) test, chi-square test and Fisher's exact test. The recurrence interval and survival time of the two groups were compared by non-parametric Wilcoxon rank sum test. Results The 2-and 3-year local recurrence rates in the laparoscopic group were both 3.0% and the overall local recurrence rate was 3.0% (3/99). The 2-and 3-year local recurrence rates in the open group were 2.6% and 4.0% , respectively, and the overall local recurrence rate was 3.5% (7/198), with no significant difference between the two groups (χ2 =0.002, P > 0. 05). The median survival time of patients with local recurrence was 15 months (range, 7-24 months) in the laparoscopic group and 11 months (range, 2-28 months) in the open group, with no significant difference between the groups (U = 15. 500, P >0. 05). The 1-year survival rate was 33.3% in the laparoscopic group and 42.9% in the open group. The 2-year survival rate was zero in the laparoscopic group and 42. 9% in the open group. There were no significant differences between the groups for the 1-and 2-year survival rates (χ2 =0.120, P>0.05). Conclusions The efficacy of laparoscopic radical resection for colorectal cancer is similar to that of open surgery. Laparoscopic radical resection for colorectal cancer is safe and feasible, and does not increase the recurrence rate of cancer.     

全腹腔镜全胃切除术消化道重建方式选择——圆形还是侧侧吻合?

正所剑(吉林大学第一医院胃结直肠肛门外科)胃癌的腹腔镜下全胃切除术(laparoscopic total gastrectomy,LTG)术后的食管空肠吻合,可采用上腹部切口后,使用吻合器常规吻合,称之为腹腔镜辅助全胃切除术(laparoscopyassisted total gastrectomy,LATG);全腹腔镜全胃切除术(totally laparoscopic total gastrectomy,TLTG)的消化道重建     

完全腹腔镜解剖性右半肝切除四例

目的 探讨腹腔镜下右半肝切除的方法 和临床效果.方法 于完全腹腔镜下解剖、阻断相应肝段、肝叶的入出肝血流,按解剖学标志切除右半肝共4例,其中3例右肝血管瘤、1例外伤性肝破裂.结果 4例患者均成功地在腹腔镜下施行了右肝切除术,无中转开腹,手术时间(470±42.7)min,术中出血量(1950±881.3)ml,术后住院(15±2.9)d,未发现并发症.结论 对于经过临床选择的病例,完全腹腔镜右半肝切除是安全可靠的微创方法,对肝脏良性疾病完全腹腔镜下病灶切除更具微创意义.

Abstract：

Objective To explore the method and clinical effect of laparoscopic anatomical right liver resections. Method The candidates for laparoscopic right hepatic lobectomys were 4 cases including 3 cases of liver hemangioma and 1 case of hepatorrhexis. Results The laparoscopic right hepatic lobectomy we performed saccess bully in all the 4 patients, operation time was (470±42.7)min. The blood loss in operation was ( 1950± 881.3) ml. The postoperative hospital stay was ( 15 ± 2.9) days.There was not complcation. Conclusions Laparoscopic right hepatic libectomy is feasible and safe.For the patients with benign liver disease, it is an operation with less operation wound.     

一种勿需缝合的完全腹腔镜胃肠毕Ⅱ式吻合技术

目的探讨一种新的勿需缝合的完全腹腔镜下胃肠毕Ⅱ式吻合技术的安全性和可行性。方法2011年5．7月间第四军医大学西京消化病医院采用自行设计的吻合技术完成完全腹腔镜胃癌D2根治术12例。该术式采用环形吻合器行胃空肠吻合,再用切割闭合器于肠壁开口处行空肠输入袢或输出袢侧侧吻合,最后关闭肠壁开口。结果12例完全腹腔镜胃大部切除术均获成功,无中转开腹或中转腹腔镜辅助手术;手术时间（196．O±19．3）min,术中出血量（169．5±28．8）ml。切除淋巴结（25．1±3．3）枚,近端切缘和远端切缘分别为（8．8±2．4）cm和（6．9±5．5）cm。术后首次排气时间平均为（3．1±1．3）d,术后住院时间（4．5±1．9）d,住院期间内均未观察到明显并发症。结论该吻合技术操作简单、快捷,勿需镜下手工缝合．用于完全腹腔镜胃大部切除重建手术安全、可行。     

完全腹腔镜结肠切除术的手工缝合重建

目的探讨完全腹腔镜结肠切除术中手工缝合重建的安全性与可行性。方法总结分析西京消化病医院结肠良性疾病（良性局部病变5例）和结肠癌（升结肠癌4例、横结肠癌2例和乙状结肠癌8例）共计19例连续病例应用手工缝合技术进行完全腹腔镜下肠道缝合重建的临床资料。所有患者均由同一组腹腔镜外科医生主刀完成手术．包括完全腹腔镜下结肠病灶局部切除手工肠道重建．右半结肠切除后回肠末端横结肠手工吻合及结肠的手工荷包缝合。结果完全腹腔镜结肠切除重建时．镜下手T缝合肠道重建11例．近端手工荷包缝合后环形吻合器吻合8例。镜下手工吻合时间为（49．5±29．4）min,荷包缝合时间为（13．3±5．5）min。术后未观察到吻合相关并发症。1例横结肠脂肪瘤患者术后发生轻度腹腔感染,经保守治疗后治愈。结论完全腹腔镜结肠切除术中手工缝合重建安全、可行;但需由经验丰富的腹腔镜外科医生实施。     

腹腔镜与开腹胃癌根治术治疗早期胃癌的临床对照研究

目的 探讨腹腔镜胃癌根治术在早期胃癌治疗中的临床应用.方法 回顾性分析2004年10月至2009年12月间分别接受腹腔镜胃癌根治术（LAP组）及开腹胃癌根治术（OPEN组）的204例早期胃癌患者的临床资料.LAP组78例,OPEN组126例;比较两组患者手术方式、手术时间、术中失血量、术后肛门排气时间、术后住院天数、并发症、术后病理和随访结果.结果 手术时间LAP组为（202.9±45.6）min,显著低于OPEN组的（219.8±45.2）min（P＜0.05）;术中失血量LAP组为（144.5±146.5）ml,显著低于OPEN组的（245.0±146.4）ml（P＜0.05）.术后第1次肛门排气时间LAP组为（3.1±1.1）d,OPEN组为（4.5±1.6）d（P＜0.05）;术后第1次进食时间LAP组为（5.2±1.9）d,OPEN组为（7.0±3.6）d（P＜0.05）;术后住院天数LAP组为（10.8±1.2）d,OPEN组为（12.4±3.8）d（P＜0.05）.术后短期并发症发生率LAP组10.3%,OPEN组12.7%（P＞0.05）.手术上、下切缘距离肿瘤为LAP组为（4.0±1.9）cm和（3.6±1.7）cm,OPEN组则为（4.2±1.7）cm和（3.5±1.8）cm（p＞0.05）,差异无统计学意义.手术平均清扫淋巴结数LAP组为（13.1±6.5）枚,OPEN组则为（14.5±8.2）枚（P＞0.05）,差异也无统计学意义.术后LAP组中位随访22（2～64）个月,无肿瘤复发和远处转移;OPEN组中位随访24（3～65）个月,1例死于肿瘤腹膜转移.两组患者住院期间的总费用比较,差异无统计学意义（P＞0.05）.结论 腹腔镜胃癌根治术是治疔早期胃癌安全、可行、微创、有效的手术方法.     

Totally Laparoscopic Billroth II Gastrectomy with a Novel,Safe, Simple,and Time-Saving Anastomosis by Only Stapling Devices

Background  

Totally laparoscopic gastrectomy represents the evolution of laparoscopy-assisted gastrectomy. Most surgeons prefer laparoscopy-assisted gastrectomy rather than totally laparoscopic procedures because of technical difficulties of intracorporeal anastomosis. We created one novel stapling anastomosis without hand-sewn technique in totally laparoscopic Billroth II gastrectomy. The feasibility and early surgical outcomes of totally laparoscopic Billroth II gastrectomy with stapling anastomosis and with hand-sewn anastomosis were introduced in this study.     

完全腹腔镜下远端胃癌根治术25例临床分析

目的探讨完全腹腔镜下远端胃癌根治术的技术可行性和应用安全性。方法回顾性分析2011年12月至2013年1月间在烟台毓璜顶医院接受完全腹腔镜下远端胃癌根治术的25例患者的临床资料,所有患者在胃癌切除后均通过直线切割缝合器于腹腔镜下完成Delta吻合重建或Roux．en．Y吻合重建。结果25例患者均在完全腹腔镜下成功完成远端胃切除和消化道重建,其中Delta吻合19例,Roux—en—Y吻合6例。Delta吻合时间（35．7±8．4）min,手术总耗时（256＋23．6）min;Roux—en—Y吻合时间（46．4±12．1）min,手术总耗时（287＋11．5）min。25例病例术中出血量（109．6±42．3）ml,术中应用腔内切割缝合器钉仓平均5．6枚／例。术后肛门排气时间（2．8±1．2）d,恢复流食时间（3．5±0．9）d。术后发生并发症3例（12．0％）,分别为腹腔内出血、腹腔内感染和短期胃瘫各1例。结论腹腔镜远端胃癌根治性切除后,采用直线切割缝合器完成腹腔镜下消化道重建安全可行。     

Intracorporeal Billroth 1 reconstruction by triangulating stapling technique after laparoscopic distal gastrectomy for gastric cancer

As the laparoscopic operations for gastric cancer have increased, the intracorporeal reconstruction of the digestive tract has received attention because the procedure offers a good visual field regardless of the patient's figure. We performed laparoscopic gastrectomies with regional lymph node dissection on 586 gastric cancer patients between March 1998 and June 2006: 465 distal gastrectomies, 42 proximal gastrectomies, and 79 total gastrectomies. Intracorporeal anastomosis was carried out in 303, 36, and 69 of the above cases, respectively. The intracorporeal Billroth 1 reconstruction was performed in 226 out of the 303 cases who underwent distal gastrectomy and intracorporeal anastomosis. The "triangulating stapling technique" (TST) that uses laparoscopic linear stapling devices was adopted for 196 of these 226 cases; in the remaining 30, circular stapling devices for conventional open gastrectomy (CEEA) were used. In the initial 115 cases of distal gastrectomy, hand-assisted laparoscopic surgery (HALS) was used, and then we shifted to totally laparoscopic distal gastrectomy (TLDG) without HALS. In this paper, we concentrated on the techniques and results of intracorporeal Billroth 1 reconstruction by TST. Reducing postoperative wounds was possible TLDG by TST, compared with HALS and the extracorporeal anastomosis, that is, laparoscopy-assisted distal gastrectomy. Complications from anastomosis resulted in leakage in 2 HALS-TST patients and in 1 TLDG-TST patient, and anastomotic stenosis and bleeding were observed in each 1 case of reconstruction that used CEEA. Intracorporeal Billroth 1 reconstruction by TST is a safe procedure that provides a good visual field regardless of the patient's figure and a feasible technique for reconstruction after laparoscopic distal gastrectomies.     

达芬奇机器人与腹腔镜行胃癌根治术的对照研究

目的：探讨全机器人系统进行胃癌根治术的安全性和有效性。方法回顾性分析2012年1月至2013年7月间在南京军区南京总医院行机器人胃癌根治术的100例胃癌患者（机器人组）的临床资料,并选取同期行腹腔镜胃癌根治术的100例胃癌患者作为对照（腹腔镜组）。腹腔镜组均采用辅助小切口行体外消化道重建,机器人组则采用体内镜下行消化道重建。结果所有机器人组患者均顺利完成手术,而腹腔镜组有1例因术中出血中转开腹。机器人组较腹腔镜组手术切口短[（4．2±1．7） cm比（8．9±2．6） cm, P＝0．028],术中出血少[（60±16） ml比（98±17） ml, P＝0．005],手术时间长[（237±46） min比（188±52） min, P＝0．001],术后住院时间短[（5．3±2．6） d比（6．1±3．1） d, P＝0．018],但两组淋巴结清扫数目、肿瘤上下切缘距离、术后排气时间及术后并发症发生率方面的差异均无统计学意义（均P＞0．05）。结论全机器人系统行胃癌根治术安全、有效,较腹腔镜手术短期效果更佳。     

双通道吻合技术在早期胃癌腹腔镜近端胃切除术消化道重建中的应用价值

目的:探讨双通道法应用于早期胃癌近端胃切除术中的临床价值及疗效。方法:回顾分析2015年1月至2016年12月接受腹腔镜胃癌D2根治术的41例胃癌患者的临床资料,其中19例于近端胃切除术中采用双通道法行消化道重建(双通道组),22例于全胃切除术中采用空肠食管吻合法行消化道重建(传统组)。对比分析两组手术时间、消化道重建时间、出血量、术后并发症、术后进食时间及住院时间。结果:两组均顺利完成手术,无一例中转开腹,双通道组消化道重建吻合时间[(33.76±6.95)min vs.(34.5±5.12)min]、术中出血量[(91.59±19.28)mL vs.(93.40±21.14)mL]、淋巴结清扫数量[(28.00±5.21)枚vs.(27.40±4.47)枚]、术后排气时间[(4.24±1.75)d vs.(4.25±2.10)d]及术后住院时间[(12.53±3.28)d vs.(13.60±3.62)d]与传统组相比差异均无统计学意义;两组术后并发症发生率[5.3%(1/19)vs.31.8%(7/22)]差异有统计学意义(P<0.05)。术后平均随访(23±11)个月,双通道组出现肠梗阻1例(5.3%),无远期并发症发生;传统组出现反流性食管炎2例(9.1%),营养不良5例(22.7%);两组均无肿瘤复发及死亡病例。结论:近端胃切除术中采用双通道吻合法较空肠食管(Roux-en-Y)吻合法更具优势,值得进一步推广应用。     

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??Totally laparoscopic total gastrectomy for gastric cancer with intracorporeal hand-sewn esophagojejunostomy??An analysis of 9 cases DAI Fa-xiang*??XUAN YI??YU Sheng-jia??et al. *Department of Gastric Cancer and Soft Tissue Sarcoma??Shanghai Cancer Center??Fudan University??Department of Oncology??Shanghai Medical College??Fudan University??Shanghai200032??China
Corresponding author??HUANG Hua??E-mail??huahuang@fudan.edu.cn
Abstract Objective To investigate the feasibility and safety of totally laparoscopic total gastrectomy (TLTG) with esophagojejunostomy intracorporeal hand-sewn reconstruction. Methods The clinical data of 9 cases underwent TLTG with esophagojejunostomy intracorporeal hand-sewn reconstruction between January 2015 and December 2015 in Shanghai Cancer Center??Fudan University was analyzed retrospectively. Results A total of 8 cases of suture succeeded while 1 case failed. The operation time was (209.9 ± 25.0) min. The anastomosis time was (51.9 ± 8.4) min. The amount of bleeding during surgery was (59.7 ± 12.6) mL. The first flatus time was (3.8 ± 1.2) d. The postoperative hospital stay was (8.9 ± 1.5) d. The postoperation recovered well without serious complications. Conclusion TLTG with esophagojejunostomy intracorporeal hand-sewn reconstruction is safe and feasible.     

腹腔镜根治性全胃切除治疗胃底贲门癌的临床研究

目的 探讨腹腔镜根治性全胃切除治疗胃底贲门癌的临床疗效和可行性.方法 回顾性分析2007年4月至2009年4月福建医科大学附属协和医院收治的176例胃底贲门癌行根治性全胃切除患者的临床资料,其中腹腔镜全胃切除81例(LATG组),开腹全胃切除95例(OTG组).比较两组患者术中及术后、淋巴结清扫、并发症发生率及病死率情况.计量资料采用t检验,计数资料采用x2检验.结果 两组患者均成功完成手术.LATG组和OTG组患者术中出血量分别为(98±84)ml和(339±245)ml,术中输血例数分别为3例和19例,术后肛门排气时间分别为(3.9±1.1)d和(5.0±1.6)d,术后住院时间分别为(13±5)d和(15±5)d,其差异有统计学意义(t=4.16,x2=6.82,t=4.57,2.83,P<0.05).LATG组和OTG组患者平均淋巴结清扫数目分别为(28±12)枚和(29±11)枚,其差异无统计学意义(t=0.42,P＞0.05);按肿瘤浸润深度进行分层分析,LATG组和OTG组患者T1、T2、T3期平均淋巴结清扫数目分别为(21±8)、(25±7)、(29±11)枚和(29±12)、(31±9)、(28±11)枚,其差异无统计学意义(t=1.53,1.90,0.65,P＞0.05).LATG组和OTG组患者术后并发症发生率和病死率分别为11%(9/81)、0和19%(18/95)、1%(1/95),其差异无统计学意义(x2=2.07,1.18,P＞0.05).结论 腹腔镜根治性全胃切除能达到与开腹手术相同的根治效果,且具有安全、术后恢复快等优点.