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目的探讨腹腔镜早期胃癌根治性手术的临床应用价值。方法回顾性分析2004年10月至2007年5月上海交通大学医学院附属瑞金医院31例早期胃癌行腹腔镜辅助胃癌根治术的临床资料,包括手术方式、手术时间、术中失血、术后排气时间、术后住院天数、并发症、术后病理和随访等。结果所有手术均在腹腔镜下完成,其中腹腔镜辅助远端胃切除术28例,近端胃切除术2例,全胃切除术1例。腹腔镜下胃周围淋巴结清扫(D1+α)16例,胃周围淋巴结+肝动脉旁淋巴结清扫(D1+β)2例,扩大淋巴结清扫(D2)13例。手术时间195(90~280)min,术中失血146(40~800)mL,术后排气时间1.8(1~4)d,术后住院天数10.8(7~20)d,1/31例(3.2%)病人出现术后吻合口瘘,经非手术治疗后痊愈。手术上、下切缘距离肿瘤为3.8(1~8)cm和3.5(1.5~7.0)cm,手术清扫淋巴结9.6(2~19)枚。术后随访14(2~32)个月,均无肿瘤复发和远处转移。结论腹腔镜辅助胃癌根治术是治疗早期胃癌安全、可行、微创、有效的方法。
Objective To investigate the clinical value of radical surgery for early laparoscopic gastric cancer. Methods The clinical data of laparoscopic-assisted radical gastrectomy in 31 patients with early gastric cancer from Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine from October 2004 to May 2007 were analyzed retrospectively. The clinical data including operation mode, operation time, intraoperative blood loss, Gas time, postoperative hospital days, complications, postoperative pathology and follow-up. Results All the operations were performed under laparoscopy. Among them, laparoscopic assisted distal gastrectomy was performed in 28 cases, proximal gastrectomy in 2 cases and total gastrectomy in 1 case. 16 cases of laparoscopic gastric lymph node dissection (D1 + α), 2 cases of peripheral lymph node + hepatic artery lymph node dissection (D1 + β) and 13 cases of enlarged lymph node dissection (D2). The operative time was 195 (90-280) min, the intraoperative blood loss was 146 (40-800) mL, the postoperative exhaust time was 1.8 (1-4 days), the postoperative hospital stay was 10.8 (7-20) days and 1/31 (3.2%) patients with postoperative anastomotic leakage, recovered after non-surgical treatment. Operative, the lower edge of the tumor from the tumor was 3.8 (1 ~ 8) cm and 3.5 (1.5 ~ 7.0) cm, 9.6 lymph node dissection (2 ~ 19) pieces. All the patients were followed up for 14 (2 ~ 32) months without recurrence and distant metastasis. Conclusions Laparoscopic assisted radical gastrectomy is a safe, feasible, minimally invasive and effective method for early gastric cancer.