刮吸解剖法在腹腔镜胃癌根治术中的临床应用

目的探讨腹腔镜胃癌根治术中应用刮吸解剖法的临床疗效。方法回顾性分析2008年6月至2011年2月绍兴市人民医院采用彭氏多功能手术解剖器实施刮吸法行腹腔镜胃癌根治术55例患者的临床资料。肿瘤位于胃上部1／3者10例，胃中部1／3者15例，胃下部1／3者30例。TNM分期：Ⅰ期16例，Ⅱ期35例，ⅢA期4例。采用门诊复诊、电话或信件等方式随访，随访时间截至2013年10月。结果55例患者均成功完成腹腔镜胃癌根治术，39例行腹腔镜远端胃大部切除术，16例行腹腔镜全胃切除术。手术时间为（2414-42）min，术中出血量为（273±115）mL，淋巴结清扫数目为（32±9）枚，手术切除标本近、远切缘距肿瘤边缘距离分别为（5．8±1．4）cm和（5．14±1．7）CITI。术后肛门排气时间为（784±24）h，术后进流质饮食时间为（95±17）h，术后住院时间为（12±4）d。术后并发症发生率为7．3％（4／55），其中肺部感染2例、吻合口漏1例、切口感染1例，均经对症治疗后好转。无围手术期死亡患者。55例患者全部获得随访。平均随访时间为35．9个月（12．0～55．0个月）。术后48个月累积生存率为54．8％。术后肿瘤复发转移率为10．9％（6／55），其中腹膜转移2例、肝脏转移1例、腹主动脉旁淋巴结转移1例、残胃转移1例、骨转移1例。结论刮吸解剖法应用于腹腔镜胃癌根治术安全、可行，具有创伤小，并发症少，术后恢复快等优点，临床疗效较满意。

Clinical application of curettage and aspiration technique in laparoscopic radical gastrectomy

Objective To investigate the clinical efficacy of the curettage and aspiration technique in laparoscopic radical gastrectomy for the treatment of gastric cancer. Methods The clinical data of 55 patients who received laparoscopic radical gastrectomy by curettage and aspiration technique with Peng＇s multifunctional opera- tive dissector at the Shaoxing People＇s Hospital from June 2008 to February 2011 were retrospectively analyzed. Tumors located at the upper stomach in 10 patients, at the middle stomach in 15 patients and at the lower stomach in 30 patients. The numbers of patients had tumor in TNM stage I ,Ⅱ,ⅢA were 16, 35 and 4. Patients were followed up via phone call and out-patient examination till October 2013. Results Laparoscopic radical gastrectomy was successfully carried out on all the 55 patients. Of the 55 patients, 39 received laparoscopic distal subtotal gas- trectomy and 16 received laparoscopic total gastrectomy. The operation time, volume of intraoperative blood loss, number of lymph nodes dissected, distances of proximal and distal resection margins to the tumors, time to flatus, time to fluid diet and duration of postoperative hospital stay and incidence of postoperative 7complications were （241± 42）minutes, （273±115）mL, 32 ±9, （5.8 ±l.4）cm, （5.1±l.7）cm, （78±24）hours, （95 ±1）hours, （12 ±4）days and 7.3% （4/55）, respectively. Two patients were complicated with pulmonary infection, 1 with anastomotic fistula, 1 with incisional infection, and all of them were cured by symptomatic treatment. No patients died perioperatively. All the 55 patients were followed up for 12.0-55.0 months, and the mean time of follow-up was 35.9 months. The cumulative 48-month survival rate was 54.8%. The postoperative recurrence and metastasis rate was 10.9% （6/55）. Peritoneal metastasis was detected in 2 patients, liver metastasis in 1 patient, para-aortie nodes metastasis in 1 patient, residual gastric metastasis in 1 patient, and bone metastasis in 1 patient. Conclusion Laparoscopic radical gastreetomy by curettage and aspiration technique is safe and feasible, with the advantages of minimal trauma, low morbidity and quick recovery.