腹腔镜胃癌根治术24例报告

目的探讨无瘤技术在腹腔镜胃癌根治术中的价值。方法 2002年5月～2008年9月,实施腹腔镜胃癌根治术24例,在遵循肿瘤根治术原则下实施无瘤技术以减少或防止肿瘤细胞的脱落、种植和播散等。结果 24例均完成腹腔镜下肿瘤根治术。D1淋巴清除术3例,D2淋巴清除术21例。手术时间(149.1±35.4)min;术中出血量(152.5±87.7)ml。术后发生吻合口出血1例,非手术治疗止血。未发生吻合口瘘、吻合口梗阻、十二指肠残端瘘等并发症。24例随访3～24个月,3例(12.5%)术后复发或转移:1例Ⅱ期肝转移,2例Ⅲ期病人分别出现食管空肠吻合旁种植转移和骨转移,均为D2淋巴清除术。结论腹腔镜下胃癌根治术中严格掌握手术入选标准,术中标准的根治范围和严格遵循癌症手术的无瘤原则,可取得与开放手术相同的效果。

Laparoscopic Radical Gastrectomy: Report of 24 Cases

Objective To explore the value of tumor-free technique in laparoscopic radical gastrectomy. Methods A total of 24 patients with gastric carcinoma received laparoscopic radical resection of the tumor in our hospital from May 2002 to September 2008. During the operation,following the principle of radical resection of carcinoma,tumor-free technique was used to prevent or reduce the tumor cells detachment,implantation,and metastasis. Results Laparoscopic radical gastrectomy was completed successfully in all of the cases with D1 lymphadenectomy being performed in 3 patients,and D2 lymphadenectomy in 21 cases. The mean operation time was （149.1±35.4） minutes,and mean intraoperative blood loss was （152.5±87.7） ml. After the operation,one patient developed anastomotic hemorrhage,and was cured by non-surgical method. No anastomotic leakage or obstruction,or duodenal stump fistula was observed in this series of patients. They were followed up for 3 to 24 months,during which 3 patients （12.5%） showed recurrent or metastatic carcinoma,including 1 case of stage Ⅱ liver metastasis,and 2 cases of stage Ⅲ bone metastasis and implantation to the anastomosis of the esophagus and jejunum,post-D2 lymphadenectomy. Conclusions By strictly following the surgical indications,standard scope for radical gastrectomy,and non-tumor principle,laparoscopic radical gastrectomy can achieve the same outcomes as laparotomy in the treatment of gastric carcinoma.