摘要
目的探讨腹腔镜在进展期胃癌患者术前探查及胃癌根治术中的临床应用价值。方法回顾性分析2008年7月～2009年9月收治的30例进展期胃癌患者的临床资料,包括术前腹腔镜分期、手术方式、手术时间、术中出血、术后胃肠功能恢复时间、术后下床活动时间、开始进流质饮食时间、术后病理和随访等。结果在30例术前临床分期均未发现腹膜转移的患者中,腹腔镜探查发现有腹膜转移者9例,4例广泛转移未行手术治疗,5例经腹腔镜探查后发现肿瘤腹膜局限性转移,行姑息性手术,余均行根治性手术。26例腹腔镜辅助胃癌切除手术患者均在腹腔镜下成功完成手术,无中转开腹。其中腹腔镜辅助全胃切除术6例,近端胃切除术4例,远端胃切除术16例。手术平均时间:全胃切除380(350～410)min,近端胃切除276(240～350)min,远端胃切除265(250～310)min。术中平均出血量:全胃切除490(400～600)ml,近端胃切除120(50～170)ml,远端胃切除130(70～200)ml。术中均未输血。术后患者胃肠蠕动恢复时间平均3.2(2～4)天,下床活动时间为3.3(3～4)天,开始进流质时间3.9(3～5)天。所有标本病理组织学检查切缘均为阴性,平均清除淋巴结20.8枚。无术后相关并发症,近期随访未见复发和转移。结论术前腹腔镜检查能对进展期胃癌进行准确的诊断和分期,有助于治疗方案的制定及估计治疗结果与预后,避免不必要的剖腹探查。腹腔镜辅助进展期胃癌根治术是安全、可行、微创、有效的方法,且近期效果良好。
Objective To evaluate the application of laparoscopic in preoperative exploration and radical resection of gastric cancer in patients with advanced gastric cancer. Methods The clinical data of 30 patients with advanced gastric cancer from July 2008 to September 2009 were reviewed and analyzed with preoperative laparoscopic staging, the surgical procedure, operative time, blood loss, post- operative recovery of gastrointestinal function time, postoperative ambulation, time to eat liquid diet, pathological and follow - up and so on. Results Laparoscopy found 9 cases of peritoneal metastases which were considered no metastasis according to preoperative clinic staging,and unfeasible operations were avoided in 4 patients because of numerous metastases to the distant peritoneum, palliative operations were performed in 5 patients because partial peritoneal metastases were discovered in laparoscopic staging,and 21 patients underwent radical surgery. Twenty-six cases were successfully performed by laparoseopy and one case was converted to open surgery. Laparoscopie assisted total gastreetomy was performed in 6 cases, proximal gastrectomy in 4 eases, distal gastrectomy in 16 cases. The average operative time for total gastreetomy, proximal gastrectomy and distal gastreetomy was 380 （ 350 - 410） min, 276 （ 240 -350 ） min and 265 （250 -310） min respectively. The average blood loss in total gastrectomy, proximal gastrectomy and distal gastrectomy was 490 （ 400 - 600） ml, 120（50 - 170）ml and 130（70 -200）ml respectively. No blood transfusion was used in patients during the operation. The average time of gastrointestinal function recovery was 3.2 （2 - 4） days. The average time for postoperative ambulation was 3.3 （3 - 4 ）. The average time to start liquid diet was 3.9 （3 - 5） days. Histopathological examination of all specimens margins was negative,and the mean total number of lymph nodes dissected was 20.8. There was no postoperative complication. The short - term outcomes were satisfactory. There was no recurrence and metastasis. Conclusion Laparoscopy was a safe and useful technique in the staging of gastric cancer, which offered a better therapeutic scheme and helped to estimate treatment results and prognosis to avoid unnecessary laparoscopy. Laparoscopic radical gastreetomy is a safe, feasible, minimally invasive and effective technique with good short - term outcomes for patients with advanced gastric cancer.
出处
《医学研究杂志》
2011年第3期48-50,共3页
Journal of Medical Research
基金
全军医学科学技术研究"十一五"计划项目(06MA082)
关键词
腹腔镜
进展期胃癌
Laparoscopic
Advanced gastric cancer
