腹腔镜胃癌D2根治术在进展期胃癌中的应用探讨

目的探讨腹腔镜下胃癌D2根治术治疗进展期胃癌的可行性。方法对2008年1～8月32例进展期胃癌行腹腔镜下D，根治术，根治性远端胃大部切除术清扫1、3、4、5、6、7、8、9、11p、12a、14v组淋巴结；根治性近端胃大部切除术清扫1、2、3、4、7、8、9、10、11组淋巴结；根治性全胃切除术清扫1、2、3、4、5、6、7、8、9、10、11、12a、14v组淋巴结；所有患者均于上腹部做辅助小切口行病灶移除及消化道重建。结果32例均顺利完成腹腔镜下胃癌D2根治手术，无中转开腹，其中根治性远端胃切除18例，根治性近端胃切除2例，根治性全胃切除12例。远、近端胃根治性切除术时间250～390min，平均325min；全胃根治性切除300—450min，平均347min。术中出血量：远、近端胃根治性切除术50～250ml，全胃根治性切除术60—350ml，术中均未输血。所有标本切缘均阴性。排气时间24—72h，平均38h；进流质时间2～5d，平均2．8d；无吻合口漏等手术相关并发症。30例随访1～8个月，未见复发和转移，亦未发生切口和穿刺口种植。结论腹腔镜下胃癌D2根治术应用于治疗进展期胃癌，安全、可行、有效、创伤小且近期效果良好。

Laparoscopic D2 Radical Gastrectomy for Staging Gastric Carcinoma

Objective To evaluate the feasibility of laparoscopic D2 radical gastrectomy for staging gastric carcinoma.Methods From January 2008 to August 2008,a series of 32 patients with staging gastric tumor underwent laparoscopic D2 radical gastrectomy in our hospital.For distal gastrectomy,groups 1,3,4,5,6,7,8,9,11p,12a,and 14v lymph nodes were resected,while for proximal gastrectomy groups 1,2,3,4,7,8,9,10,and 11 lymph nodes were excised.In the patients who received total radical gastrectomy,the groups 1,2,3,4,5,6,7,8,9,10,11,12a,and 14v were harvested.Reconstruction of the digestive tract was performed after the resected tumor was removed through a mini-incision on the upper abdomen.Results The procedure was completed in all of the patients without conversion to open surgery.The distal gastrectomy was performed on 18 patients,and the proximal surgery was carried out in 2.The operation time and intraoperative blood loss for the two surgeries was 250-390 minutes(mean,325) and 50-250 ml,respectively.Total radical gastrectomy was employed in 12 cases with a mean operation time of 347 min(300-450),and blood loss of 60-350 ml.None of the 32 patients needed blood transfusion.Postoperative pathological examination showed that the edge of the resected samples were negative in all of the cases.They had the gastrointestinal function recovered in 24 to 72 hours(mean,38),and began fluid diet in 2 to 5 days(mean,2.8).No patient had anastomotic leakage or other complications.Thirty of the cases were followed up for 1 to 8 months.During the period,no recurrence,metastasis,or implantations at the incision or puncture sites were found.Conclusion Laparoscopic D2 radical gastrectomy is a safe,feasible,effective and minimally invasive technique with good short-term outcomes for patients with staging gastric carcinoma.