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。

Clinical application of laparoscopic radical total gastrectomy

Objective To investigate the feasibility, security and short-term effect of clinical applications of full laparoscopic radical total gastrectomy. Methods A retrospective analysis of 139 patients of the surgical radical gastrectomy in our hospital between January of 2008 to December of 2012. Of which, there were 69 cases of laparoscopic radical total gastrectomy, 70 cases of abdominal radical total gastrectomy. There were no statistically significant （P 〉 0.05） in age, gender, and clinical TNM staging. All patients are accepted to the same group of surgeons. Results Sixty-nine cases of laparoscopic surgery were successfully completed, there were no conversion to open or laparoscopic-assisted and no operative mortality.The average incision length 4.3cm in TLG, 15.1cm in OP; the mean operative time is （263.6 ± 30.6） min than the laparotomy group （305.0 ± 60.2） min; average intraoperative blood loss is （352.3 ± 153.2） ml compared with the laparotomy group （142.3 ± 82.3） ml; anal exhaust time is （9.4 ± 3.5） days compared with the laparotomy group （4.2 ± 1.5） d , mean postoperative hospital stay is （13.1 ± 4.6） dthan the laparotomy group （10.22 ± 2.5） d, they were statistically significant （P 〈 0.01 ）; There were no significance （P 〉 0.05） in the average number of harvested lymph nodes （25.1 ± 10.9） pieces with the laparotomy group （24.3 ± 12.2）. 7.2% of the postoperative complications with open surgery group （12.9%）.No mortality and recurrence were observed during a follow-up period of 3-24 months. Conclusions Laparoscopic radical total gastrectomy is useful for the treatment of central gastric cancer. It is feasible for the requirements of tumor cure. Furthermore, it also has the advantages of less trauma, less bleedinz and auick recoverv.