腹腔镜进展期胃癌根治术的临床疗效

 目的　探讨腹腔镜辅助进展期胃癌根治术的安全性及可行性。方法　2006年6月至2009年7月行腹腔镜辅助下胃癌D2根治术11例，TNM分期Ⅱ期6例、ⅢA期2例、ⅢB期1例、Ⅳ期2例，腹腔镜下行胃的游离及淋巴结清扫，于剑突下约6 cm长切口施行胃切除，并行消化道重建。结果　11例中，根治性全胃切除术2例，近端胃切除术1例，远端胃切除术7例，1例中转开腹。平均手术用时：全胃切除术350 min，近端胃切除术320 min，远端胃切除术266 min。平均清扫淋巴结21.3（11～38）枚，切缘长度5.6（4.0～9.6）cm。术后患者平均胃肠功能恢复时间72（36～110）h，下床活动时间59（26～86）h，进流食时间76（48～116）h。无一例出现手术相关并发症。结论　经腹腔镜行进展期胃癌D2根治术安全、可行，与开腹手术的根治效果相当，近期效果良好，具有创伤小、术后恢复快等优点。

Clinical application of laparoscopic-assisted radical gastrectomy for advanced gastric cancer

Objective To study the feasibility and safety of laparoscopy-assisted D2 radical gastrectomy for advanced gastric cancer. Methods From June, 2006 to July 2009, 11 patients with gastric cancer received laparoscopy-assisted gastrectomy for gastric cancer. According to UICC TNM classification of gastric cancer, 6 cases were with Stage Ⅱ, 2 cases with Stage Ⅲ A, 1 case with Stage Ⅲ B, and 2 cases with Stage Ⅳ. Under the assistance of laparoscope, dissociation of the stomach and lymph nodes clearance were performed first; then gastrectomy was performed on a 6 cm incision, samples were collected, and alimentary tract was inoculated. Results Among the 11 cases, 2 cases were performed radical total gastrectomy, 1 case was performed proximal partial gastrectomy, 7 cases were performed distal partial gastrectomy and 1 case with open surgery. The mean operation time: 350 min for total gastrectomy, 320 min for proximal partial gastrectom,266 min for distal partial gastrectomy. The mean number of harvested lymph nodes was 21.3 (11-38), incisal edge was 5.6 (4.0-9.6) cm. The mean time was 72 (36-110) hrs for gastrointestinal function recovery, 59 (26-86) hrs for patients to take general activity, and 76 (48-116) hrs to take liquid food. No complication was observed. Conclusion Laparoscopy-assisted D2 radical gastrectomy for advanced gastric cancer is safe and feasible. Compared with open surgery, it also has the advantages of small wound and fast recovery.