腹腔镜下胃癌全胃切除术79例的体会

目的 探讨腹腔镜下胃癌行全胃切除术的可行性及效果.方法 对2004年6月至2006年12月共行腹腔镜下根治性全胃切除术79例,其中行D1及D1+淋巴结清扫12例,D2/D2+淋巴结清扫67例.肿瘤位于胃近端者19例,位于胃体者41例,皮革胃2例,位于胃窦并浸润至胃小弯中上部者17例进行分析.结果 79例中77例成功进行腹腔镜手术,2例中转开腹,中转率为2.5%.平均手术时间(275.8±20.8) min,平均出血量(163.3±48.6) ml,平均每例清扫淋巴结(34.7±12.2) 枚,肿瘤近残端(3.8±1.2) cm,远残端(6.9±2.8) cm.术后肛门排气时间(3.6±0.9) d,下床活动时间(2.5±0.4) d.无术后死亡,无吻合口漏,术后发生并发症7例均经内科治疗痊愈.术后随访9～39个月,平均25.6个月,15例患者因肿瘤复发死亡,余64例仍生存.结论 腹腔镜下全胃切除联合胃癌标准根治术是安全可行的,能达到开腹手术的淋巴结清扫范围,且具有创伤小、出血少、恢复快、并发症率低等优点.

Laparoscopic total gastrectomy for gastric cancer: a report of 79 cases

Objective To explore feasibility and safety of laparoscopic total gastrectomy for gastric cancer. Methods A total of 79 laparoscopic total gastrectomies for gastric cancer were performed at our hospital from June 2004 to October 2006. D1 or D1 plus lymphadenectomy was performed in 12 patients, and D2 in 67. Results Except for 2 patients with conversion to open surgery, 49 patients underwent totally laparoscopic or laparoscopy-assisted total gastrectomy successfully. The mean operation time was (275.8±20.8) minutes, mean blood loss(163.3±48.6) ml, and mean lymph nodes retrieved 34.7±12.2. The proximal and distal tumor margins were (3.8±1.2) cm and (6.9±2.8) cm, respectively, with all the margins being free from cancer cells. The patients have a quicker recovery as indicated by first flatus time and time to ground activity. There was no postoperative death, with an acceptablemorbidity rate. After a mean follow-up of 25.6 months, there were 15 deaths and 12 alive patients with recurrent diseases. Conclulsions Laparoscopic total gastrectomy is feasible, safe and effective in clearance of early or advanced gastric cancer. Its merits include minimal invasiveness, less blood loss, quicker recovery, acceptable morbidity rate and decreased chance of conversion to thoracotomy.