摘要
目的研究完全腹腔镜下D2淋巴结清扫胃癌根治术（TLG）的安全性和可行性。方法回顾性分析2009年7月至2012年6月行TLG（TLG组）与腹腔镜辅助下D2淋巴结清扫胃癌根治术（LAG）（LAG组）共601例患者的临床资料,手术均由同一手术组完成。结果 TLG组150例中行远端胃切除68例,全胃切除82例。LAG组451例中远端胃切除214例,全胃切除237例。TLG组平均手术时间292min,LAG组平均手术时间为269min（P〈0.05）。TLG组平均住院时间为10.9d,LAG组平均为12.1d（P〈0.05）。术后镇痛泵的使用时间TLG组平均为6.3（0~12）h,而LAG组为21.1（0~48）h（P〈0.05）。术后平均通气时间两者分别为3.2d和3.4d（P〈0.05）。术后首次进流质饮食时间TLG组平均为3.5d,LAG组为3.7d（P〈0.05）。随访时间1~37个月（平均随访时间16.7个月）,TLG组出现并发症15例,LAG组73例,两组均无手术死亡发生。结论相较于LAG,TLG具有可接受的手术时间与并发症发生率,患者术后疼痛轻,舒适感强,通气及下床活动时间早,住院时间缩短,可作为胃癌患者一种理想的手术方法。
Objective To investigate the oncologic safety and feasibility of total laparoscopic gastrectomy （ TLG ） with D2 lymph nodes dissection. Methods Between July 2009 and June 2012, 601 patients of gastric cancer underwent TLG or LAG （ laparoscopic-assistanted gastrectomy ） with D2 dissection of lymph nodes. All patients were operated on by one group of experienced surgeons. Results Of all 150 cases underwent TLG, there were 68 of distal gastrectomy and 82 of total gastrectomy, while in LAG group of 451 cases, there were 214 of distal gastrectomy and 237 of total gastrectomy. The mean operation time in TLG was longer than in LAG of 292（ 115 - 610 ）min v.s.269（ 125 - 490 ）min（ P 0.05 ）. TLG has shorter hospital stay than LAG group [ 10.9（ 5 - 31 ）days vs.12.1（ 5 - 33 ）days,（ P 0.05 ）]. The average postoperative analgesia pump use time TLG group for 6.3 h , in group LAG for 21.1 h . The mean number of days until first flatus was 3.2（ 2 - 5 ）vs. 3.4（ 2 - 6 ）（ P 0.05 ）respectively. Oral food intake was reintroduced after a mean of 3.5（ 2 - 6 ） days vs.3.7（ 2 - 8 ） days（ P 0.05 ） respectively. No patients dead during the operation. The overall complication rate was 10.0 %（ 15 cases ） and 16.2 % （ 73 cases ） respectively after an anverage of 16.7（ 1 - 37 ） months follow up. Conclusions Though TLG is still limited to only a few centers because of the major concern about the difficulty of intracorpareal reconstruction and longer surgery time, our research showed that it＇s a reasonable, safe and technically feasible procedure, while patients experienced quicker recovery and more comfort.
出处
《中华腔镜外科杂志（电子版）》
2012年第4期36-39,共4页
Chinese Journal of Laparoscopic Surgery(Electronic Edition)
关键词
胃肿瘤
腹腔镜
胃切除术
胃肠吻合术
Stomach neoplasms
Laparoscope
Gastrectomy
Gastroenterostomy
