腹腔镜胃癌外科的发展现状与思考

腹腔镜手术以其显著的微创优势。已成为外科医生治疗早期胃癌的首选方式之一。随着腹腔镜手术经验的不断积累．目前腹腔镜胃切除术的指征已逐渐从早期胃癌扩大到进展期胃癌。但是．由于缺乏长期疗效的循证医学证据支持．腹腔镜手术在进展期胃癌中的运用尚存争议。腹腔镜胃癌手术在技术层面的要求非常高．尤其在进行D2淋巴结清扫时。因此，在开展腹腔镜胃癌手术前．规范腹腔镜操作技术和流程的培训是必须的。

Recent advances and some consideration about laparoscopic surgery in patients with gastric cancer

Laparoscopy-assisted distal gastrectomy for gastric cancer was first reported in 1994. Since then, the laparoscopic approach is rapidly becoming the preferred method of treatment for patients with early gastric cancer （EGC） due to the many advantages of minimally invasive surgery. Many retrospective comparative trials and randomized- controlled trials （RCT） have confirmed that laparoscopic gastrectomy （LG） is safe and feasible, and that short-term outcomes are better than those of open gastrectomy in patients with EGC. As laparoscopic experience has accumulated, the indications for LG have been broadened to patients with advanced gastric cancer （AGC）. However, the role of LG remains controversial, because studies of the long-term outcomes of LG are insufficient. Laparoscopic gastric surgery is demanding from a technical point of view, especially when aD2 lymphadenectomy is performed. Adequate training in laparoscopic techniques and procedures is mandatory prior to embarking on a LG.