腹腔镜、胃镜双镜联合治疗胃部肿瘤的临床应用

目的评价腹腔镜、胃镜联合治疗胃部肿瘤的临床应用效果。方法行腹腔镜胃部肿瘤手术34例,术中结合胃镜行病变定位,其中行腹腔镜下全胃切除5例,腹腔镜下近端胃大部切除术3例,腹腔镜下远端胃大部切除术26例,腹腔镜下胃手术同时行腹腔镜胆囊切除术3例。结果 2例在腹腔镜下完成胃的分离、切除、吻合;32例先腹腔镜分离,然后通过上腹正中切一个5～8 mm切口,进行胃的切除、吻合,标本亦于此切口取出。无中转开腹病例。手术时间60-395分钟,术中出血30～200 mL,肠蠕动恢复时间28-60小时,下床活动时间36-48小时,进流质时间3-5天,本组病例无1例应用镇痛剂,未出现吻合口漏、腹腔出血、切口感染等并发症,仅有1例患者出现食管黏膜糜烂出血,治疗后痊愈。21例患者术后规律随访6月,未发现操作孔、小切口及腹腔内转移。结论腹腔镜、胃镜联合手术治疗胃部肿瘤具有微创、疼痛轻、胃肠功能恢复快、下床、住院时间短、切口小、对机体免疫功能影响小、术后恢复快等优点。

Combined use of laparoscopy and gastroscopy in treatment of gastric tumor

Objective To evaluate the efficacy of combined use of laparoscopy and gastroscopy in treatment of gastric tumor.Methods The clinical data of 34 patients with gastric tumor undergoing laparoscopic gastrectomy were retrospectively reviewed.Gatroscopy was applied to locate the tumor during the surgery.Among this group of patients there were 5 cases of total gastrectomy,3 cases of proximal gastrectomy,26 cases of distal gastrectomy;and laparoscopic cholecystectomy was performed along with gastrectomy in 3 cases.Results Total laparoscopic gastrectomy was performed in 2 cases;for other 36 cases dissection was performed under laparoscope and a 5～8 cm assistant incision was made for removal of specimen and completion of anastomosis.The operating time was 60-395 min,the volume of blood lose was 30～200 mL.It took the patients 28-60 h to have bowel movement,36-48 h to get down from their beds,and 3-5 d to take in liquid diet.No analgesia treatment was applied.Only one patient had hemorrhage due to mucosal erosion of the esophagus,no other short-term complications including anastomotic leakage,intraperitoneal hemorrhage,incision infection were observed.Twenty-one patients were followed up for 6 months,there were no metastasis to the trocar site,assistant incision or inside the peritoneal cavity.Conclusion The advantages of combined use of laparoscopy and gastroscopy in gastrectomy are minimal invasion,less pain,shorter hospital stay and rapid recovery.