Laparoscopy-assisted distal gastrectomy for early gastric cancer

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.     

Hand-assisted laparoscopic surgery (HALS): a report of 150 procedures

Background: This study was performed to evaluate the (long-term) morbidity associated with hand-assisted laparoscopic surgery (HALS) for various indications. Methods: HALS procedures for various indications were evaluated prospectively from 1995 to 2002. The primary outcome parameters were postsurgical complications and the development of incisional hernias. Results: Twenty-six splenectomies, 51 hand-assisted laparoscopic donor nephrectomies (HLDN), 34 segmental bowel resections, 29 proctocolectomies, and 10 emergency colectomies were evaluated. A Küstner or Pfannenstiel incision was used for handport placement. Minor complications (i.e., wound complications, urinary tract infection) occurred in 15%, 12%, 26%, 7%, and 33% of the patients after, respectively, splenectomy, HLDN, bowel resection, proctocolectomy, and emergency colectomy. Major complications (i.e., hemorrhage, anastomotic leakage) occurred in 15% and 12% of the patients after, respectively, bowel resection and proctocolectomy. Incisional hernias occurred in six patients (4%), all after a wound complication in the Küstner incision. Conclusion: HALS is fast, safe, and feasible for various indications, especially HLDN and (procto-)colectomies. Little advantage can be expected when HALS is applied in splenectomy and segmental bowel (sigmoid) resection.     

Hand-assisted laparoscopic distal gastrectomy with abdominal wall-lift method

We performed a hand-assisted laparoscopic resection of the distal stomach for treatment of gastric cancer with use of an abdominal wall-lift method. The surgeon's left hand, which was inserted through a right lower quadrant incision, was extremely useful in accomplishing D2 lymph node dissection, application of a pursestring instrument, and approximation of a circular stapler to carry out a Billroth I anastomosis. Abdominal wall-lift enabled us to perform the gastrectomy without any concern about gas leakage. The combination of the wall-lift method and hand assistance seems to further enlarge the possibilities of laparoscopic procedures, especially in gastrointestinal surgery. Received: 22 July 1998/Accepted: 17 March 1999     

手助腹腔镜与标准腹腔镜根治性肾切除术的临床研究

目的探讨手助腹腔镜根治性肾切除术与标准腹腔镜根治性肾切除术的临床价值。方法回顾分析2010年1月至2011年12月本中心96例腹腔镜根治性肾切除术患者的临床资料,其中58例为手助腹腔镜组,38例为标准腹腔镜组。对比分析两组患者的术中、术后相关临床指标、并发症及短期随访结果。结果手助腹腔镜组和标准腹腔组的手术时间(65.3min和95.8min)、术中出血量(48.9ml和123.9ml)有明显统计学差异(P<0.05)。所有病例均进行了3～27个月的随访,均未发现肿瘤局部复发或远处转移。结论手助腹腔镜技术保留了腹腔镜手术创伤小、痛苦少、术后恢复快、并发症少等优点,并可缩短手术时间、减少术中出血及损伤周围脏器的风险。     

无蓝碟手助腹腔镜巨脾切除术15例报告

目的探讨无蓝碟手助腹腔镜下脾切除术的安全性和疗效。方法 2009年5月～2011年7月,完成手助腹腔镜巨脾切除15例（脾脏长径138～192 mm,平均169 mm）,其中6例行贲门周围血管离断术。上腹正中5～6 cm切口,左手常规进腹,超声刀离断胃结肠韧带后,用伸入腹腔的手指在胰腺上缘将脾动脉主干游离,丝线结扎,并在手指引导下于脾蒂后方穿过吻合器钉仓,击发后离断脾蒂,然后再离断脾周围韧带,完整切除脾脏。结果 15例手术均顺利完成,手术时间76～294 min,平均147 min;出血量55～1100 ml,平均292 ml。术后住院时间7～15 d,平均9.8 d。15例随访1～25个月,平均14个月,血小板在术后18～27 d内（平均24.6 d）恢复正常,术后无远期并发症。结论无蓝碟手助腹腔镜脾切除术手术时间短,术后恢复快,并发症少,是一种值得推广的安全有效的手术方法。     

手辅助腹腔镜与开腹左半结肠切除术对照研究

目的 探讨手辅助腹腔镜(HALS)左半结肠切除术的安全性、可行性.方法 将住院的50例结肠癌患者随机分为HALS组(25例)和开腹组(25例)两组,比较两组的手术时间、术中出血量、淋巴结清扫、术后肛门排气时间、术后住院时间、术后并发症及C反应蛋白的变化.结果 HALS组术中出血量少于开腹组[(83.16 ±27.61) ml比(196.76 ±59.47) ml,P＜0.05];术后肛门排气时间短于开腹组[ (45.78±11.62)h比(74.08±16.12)h,P＜0.05];术后住院时间短于开腹组[(8.24±2.46)d比(11.63±3.07)d,P＜0.05];术后6dC反应蛋白少于开腹组[(21.68±6.97)比(67.32±28.31),P＜0.05].结论 手辅助腹腔镜左半结肠切除安全有效,具有创伤小、术后恢复快等优点.     

腹腔镜辅助或手助结直肠癌根治术

目的总结腹腔镜根治术治疗13例结直肠癌的临床经验。方法回顾分析我科2002年11月-2006年4月13例腹腔镜根治术治疗结直肠癌的临床资料。结肠癌10例，Duke’s A期4例，Duke’s B期6例；直肠癌3例，均为Duke’s A期。结果13例结直肠癌根据肿瘤大小分别采取腹腔镜辅助根治术10例，手助腹腔镜根治术3例，均获成功，无中转开腹手术。无死亡病例。随访1—36个月，平均17个月，未见肿瘤复发。结论依据肿瘤大小和部位选择腹腔镜辅助或手助腹腔镜手术治疗结直肠癌，可以保证手术的安全有效性。     

手助腹腔镜下右半结肠癌根治术不同手术入路的临床疗效对比

目的:对比分析不同手助腹腔镜下右半结肠癌根治术中采用不同手术入路的临床疗效。方法 :选取2008年1月—2013年3月收治的80例右半结肠癌患者,将所有患者按随机数法分为实验组与对照组,2组均为40例。实验组接受外侧入路,对照组接受中间入路,比较2组患者术中的一般情况及短期疗效。结果:实验组手术时间(131.3±17.5)min,术中出血(57.9±16.5)m L,对照组分别为(187.3±16.2)min和(104.5±19.8)m L,实验组少于对照组(t=14.852、11.435,P均0.05),2组术中标本切除长度、淋巴结清除个数、术后体温恢复正常时间、排气时间与住院时间的差异无统计学意义(P0.05);2组并发症发生率的差异无统计学意义(10.0%vs 17.5%,χ2=0.949,P=0.330)。结论:在手辅助腔镜下右半结肠癌根治术中,外侧入路出血少,手术时间短,但中间入路更有利于解剖结构的暴露及肿瘤的根治。     

手助腹腔镜胃癌根治术102例近期疗效分析

目的:评价手助腹腔镜胃癌根治术的近期疗效。方法:回顾分析2010年12月至2012年7月为102例患者行手助腹腔镜胃癌根治术的临床资料及随访记录,统计手术效果相关指标,结果以(均数±标准差)表示,分析术后并发症及随访期间患者生存状况。结果:102例患者中2例中转开腹,中转率1.96%;53例行全胃切除术,39例行远端胃切除术,8例行近端胃切除术;其中4例联合胆囊切除术,2例联合左肝外叶部分切除术,1例联合行胰体尾部分切除+脾切除术。手术切口平均(6.81±0.29)cm;术中出血量平均(244.10±117.02)ml;手术时间平均(172.28±24.02)min;病理检获淋巴结数量平均(17.10±5.70)枚;术后平均住院(10.20±3.84)d。无手术相关死亡病例,9例发生并发症,并发症发生率9%(9/100)。术后随访1¹2个月,6例失访,失访率6%,3例发生可能与手术操作有关的继发性病变,发生率3.19%(3/94)。结论:手助腹腔镜胃癌根治术经过较系统的临床实践可取得满意的手术效果,且手术安全可靠、近期疗效良好,但远期疗效尚需进一步观察。     

手辅助腹腔镜脾切除加门奇断流术治疗门脉高压患者的应用价值分析

目的：探讨手辅助腹腔镜脾切除加门奇断流术治疗门脉高压患者的临床应用价值,并为其临床应用提供依据。方法：共纳入52例确诊为门脉高压的患者,均行脾切除加门奇断流术,采用随机数字法平均分为观察组与对照组,观察组患者行手辅助腹腔镜手术,对照组患者行开腹手术。观察两组患者手术出血量、手术时间、住院时间等,并分析其对机体应激反应（TNF-α,IL-6,CRP）的影响。结果：观察组术中出血量、手术时间及术后引流量、引流时间、肛门排气时间、住院时间明显少于对照组,差异有统计学意义（P〈0．05）;对照组切脾最大直径大于观察组,但差异无统计学意义（P〉0．05）。术后观察组患者CRP、IL-6、TNF-α水平均明显低于对照组,差异有统计学意义（P〈0．05）。结论：手辅助腹腔镜脾切除加门奇断流术治疗门脉高压患者具有较好的临床疗效,可减少术中出血量、术后引流量,缩短手术时间、住院时间,机体应激反应较小。