• 大連醫(yī)科大學(xué)附屬第一醫(yī)院普外一科(遼寧大連116011);

目的總結(jié)腹腔鏡胃癌手術(shù)并發(fā)癥的現(xiàn)狀，探討腹腔鏡下胃癌手術(shù)的陷阱和手術(shù)并發(fā)癥的預(yù)防及處理辦法。方法復(fù)習(xí)國(guó)內(nèi)、外相關(guān)文獻(xiàn)，并結(jié)合自己的臨床經(jīng)驗(yàn)進(jìn)行分析。結(jié)果腹腔鏡胃癌手術(shù)并發(fā)癥主要有手術(shù)本身和人工氣腹相關(guān)并發(fā)癥。 腹腔鏡下視野的局限，立體空間和手指觸覺(jué)的喪失，新器械、新技術(shù)的使用以及工作環(huán)境的改變，增加了手術(shù)難度和發(fā)生并發(fā)癥的可能。 清楚的鏡下手術(shù)解剖層次，正確的淋巴結(jié)清掃方法和消化道重建，是減少腹腔鏡胃癌手術(shù)并發(fā)癥發(fā)生的基礎(chǔ)。結(jié)論掌握正確的手術(shù)操作原則可以減少腹腔鏡胃癌手術(shù)并發(fā)癥的發(fā)生。

引用本文： 張健,胡祥. 腹腔鏡胃癌手術(shù)并發(fā)癥的預(yù)防和處理. 中國(guó)普外基礎(chǔ)與臨床雜志, 2011, 18(2): 122-125. doi: 復(fù)制

1. Kitano S, Iso Y, Moriyama M, et al. Laparoscopyassisted Billroth Ⅰ gastrectomy [J]. Surg Laparosc Endosc, 1994, 4(2): 146148.
2. Naka T, Ishikura T, Shibata S, et al. Laparoscopyassisted and open distal gastrectomies for early gastric cancer at a general hospital in Japan [J]. Hepatogastroenterology, 2005, 52(61): 293297.
3. Dulucq JL, Wintringer P, Stabilini C, et al. Laparoscopic and open gastric resections for malignant lesions: a prospective comparative study [J]. Surg Endosc, 2005, 19(7): 933938.
4. Lee JH, Yom CK, Han HS. Comparison of longterm outcomes of laparoscopyassisted and open distal gastrectomy for early gastric cancer [J]. Surg Endosc, 2009, 23(8): 17591763.
5. Hwang SI, Kim HO, Yoo CH, et al. Laparoscopicassisted distal gastrectomy versus open distal gastrectomy for advanced gastric cancer [J]. Surg Endosc, 2009, 23(6): 12521258.
6. Japan Society for Endoscopic Surgery. Nationwide survey on endoscopic surgery in Japan [J]. J Jpn Soc Endosc Surg, 2004, 9(7): 495500.
7. Japan Society for Endoscopic Surgery. Nationwide survey on endoscopic surgery in Japan [J]. J Jpn Soc Endosc Surg, 2008, 5(5): 525529.
8. 鄭民華, 臧潞. 腹腔鏡外科治療早期胃癌的現(xiàn)狀 [J]. 內(nèi)科理論與實(shí)踐, 2010, 5(3): 203206.
9. Goh PM, Khan AZ, So JB, et al. Early experience with laparoscopic radical gastrectomy for advanced gastric cancer [J]. Surg Laparosc Endosc Percutan Tech, 2001, 11(2): 8387.
10. Sarela AI. Entirely laparoscopic radical gastrectomy for adenocarcinoma: lymph node yield and resection margins [J]. Surg Endosc, 2009, 23(1): 153160.
11. Japanese Gastric Cancer Association. Guidelines for the treatment of gastric cancer [M]. 2nd. Eds. Tokyo: Kanehara, 2004: 4042.
12. Japanese Gastric Cancer Association. Guidelines for the treatment of gastric cancer [M]. 3rd. Eds. Tokyo: Kanehara, 2010: 3031.
13. 胡祥. 日本《胃癌治療指南》(第3版)解讀 [J]. 中國(guó)實(shí)用外科雜志, 2010, 30(1): 2530.
14. 余佩武. 胃癌腹腔鏡手術(shù)現(xiàn)狀 [J]. 臨床外科雜志, 2008, 16(10): 654656.
15. Ly QP, Sasson AR. Modern surgical considerations for gastric cancer [J]. J Natl Compr Netw, 2008, 6(9): 885894.
16. Memon MA, Khan S, Yunus RM, et al. Metaanalysis of laparoscopic and open distal gastr ectomy for gastric carcinoma [J]. Surg Endosc, 2008, 22(8): 17811789.
17. Park JM, Jin SH, Lee SR, et al. Complications with laparoscopically assisted gastrectomy: multivariate analysis of 300 consecutive cases [J]. Surg Endosc, 2008, 22(10): 21332139.
18. 余佩武. 腹腔鏡胃癌根治術(shù)的原則與評(píng)價(jià) [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009, 16(1): 15.
19. Lee JH, Han HS, Lee JH. A prospective randomized study comparing open vs laparoscopyassisted distal gastrectomy in early gastric cancer: early results [J]. Surg Endosc, 2005, 19(2): 168173.
20. Weber KJ, Reyes CD, Gagner M, et al. Comparison of laparoscopic and open gastrectomy for malignant disease [J]. Surg Endosc, 2003, 17(6): 968971.
21. Lee SI, Choi YS, Park DJ, et al. Comparative study of laparoscopyassisted distal gastrectomy and open distal gastrectomy [J]. J Am Coll Surg, 2006, 202(6): 874880.
22. Tanimura S, Higashino M, Fukunaga Y, et al. Laparoscopic gastrectomy for gastric cancer: experience with more than 600 cases [J]. Surg Endosc, 2008, 22(5): 11611164.
23. Huscher CG, Mingoli A, Sgarzini G, et al. Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: fiveyear results of a randomized prospective trial [J]. Ann Surg, 2005, 241(2): 232237.
24. Hosono S, Arimoto Y, Ohtani H, et al. Metaanalysis of shortterm outcomes after laparoscopicassisted distal gastrectomy [J]. World J Gastroenterol, 2006, 12(47): 76767683.
25. Kim HH, Hyung WJ, Cho GS, et al. Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report-a phase Ⅲ multicenter, prospective, randomized Trial (KLASS Trial) [J]. Ann Surg, 2010, 251(3): 417420.
26. 余佩武, 錢(qián)鋒, 羅華星, 等. 腹腔鏡胃癌根治術(shù)的臨床療效 [J]. 中華消化外科雜志, 2008, 7(1): 3840.
27. Kitano S, Shiraishi N, Uyama I, et al. A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan [J]. Ann Surg, 2007, 245(1): 6872.
28. 臧潞, 胡偉國(guó), 李佑, 等. 腹腔鏡早期胃癌根治術(shù)后臨床研究 [J]. 內(nèi)科理論與實(shí)踐, 2010, 5(3): 210213.
29. Ryu KW, Kim YW, Lee JH, et al. Surgical complications and the risk factors of laparoscopyassisted distal gastrectomy in early gastric cancer [J]. Ann Surg Oncol, 2008, 15(6): 16251631.
30. 錢(qián)峻, 湯黎明, 朱杰, 等. 腹腔鏡胃癌根治手術(shù)中的團(tuán)隊(duì)配合 [J]. 中國(guó)微創(chuàng)外科雜志, 2009, 9(9): 781783.
31. 吳濤, 李國(guó)新, 丁自海, 等. 腹腔鏡下遠(yuǎn)端胃癌根治術(shù)中胃背系膜及系膜間隙的解剖形態(tài)特點(diǎn) [J]. 中國(guó)臨床解剖學(xué)雜志, 2007, 25(3): 251254.
32. Ogura G, Nakamura R, Muragaki Y, et al. Development of an articulating ultrasonically activated device for laparoscopic surgery [J]. Surg Endosc, 2009, 23(9): 21382142.
33. Oz BS, Mataraci I, Iyem H, et al. Comparison of ultrasonically activated scalpel and traditional technique in radical artery harvesting: clinical research [J]. Thorac Cardiovasc Surg, 2007, 55(2): 104107.
34. 鄭勇斌, 童仕倫, 譚海燕, 等. 超聲刀在腹腔鏡胃癌根治手術(shù)中的應(yīng)用 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009, 16(10): 781784.
35. Tokunaga M, Hiki N, Fukunaga T, et al. Quality control and educational value of laparoscopyassisted gastrectomy in a highvolume center [J]. Surg Endosc, 2009, 23(2): 289291.
36. Pugliese R, Maggioni D, Sansonna F, et al. Total and subtotal laparoscopic gastrectomy for adenocarcinoma [J]. Surg Endosc, 2007, 21(1): 2127.
37. Lee JH, Kim YW, Ryu KW, et al. A phaseⅡ clinical trial of laparoscopyassisted distal gastrectomy with D2 lymph node dissection for gastric cancer patients [J]. Ann Surg Oncol, 2007, 14(11): 31483153.
38. Hao YX, Yu PW, Zhong H, et al. Comparison of laparoscopic and open gastrectomy on cancer cells exfoliating from the cancerinvaded serosa [J]. Surg Laparosc Endosc Percutan Tech, 2009, 19(3): 201207.
39. 陳凜. 腹腔鏡胃癌根治術(shù)后并發(fā)癥的預(yù)防及處理　 [J/OL]. 中華普外科手術(shù)學(xué)雜志(電子版), 2008, 2(1): 2627.
40. 李佑, 王明亮. 早期胃癌的腹腔鏡手術(shù)治療進(jìn)展　 [J/OL]. 中華腔鏡外科雜志(電子版), 2008, 1(2): 119122.
41. Varela JE, Hiyashi M, Nguyen T, et al. Comparison of laparoscopic and open gastrectomy for gastric cancer [J]. Am J Surg, 2006, 192(6): 837842.
42. 松井 英男. 食道空腸順蠕動(dòng)側(cè)側(cè)吻合口法(胃全摘後 RouxenY食道空腸側(cè)側(cè)吻合) [J]. 手術(shù), 2010, 64(10): 14551460.
  1. 1. Kitano S, Iso Y, Moriyama M, et al. Laparoscopyassisted Billroth Ⅰ gastrectomy [J]. Surg Laparosc Endosc, 1994, 4(2): 146148.
  2. 2. Naka T, Ishikura T, Shibata S, et al. Laparoscopyassisted and open distal gastrectomies for early gastric cancer at a general hospital in Japan [J]. Hepatogastroenterology, 2005, 52(61): 293297.
  3. 3. Dulucq JL, Wintringer P, Stabilini C, et al. Laparoscopic and open gastric resections for malignant lesions: a prospective comparative study [J]. Surg Endosc, 2005, 19(7): 933938.
  4. 4. Lee JH, Yom CK, Han HS. Comparison of longterm outcomes of laparoscopyassisted and open distal gastrectomy for early gastric cancer [J]. Surg Endosc, 2009, 23(8): 17591763.
  5. 5. Hwang SI, Kim HO, Yoo CH, et al. Laparoscopicassisted distal gastrectomy versus open distal gastrectomy for advanced gastric cancer [J]. Surg Endosc, 2009, 23(6): 12521258.
  6. 6. Japan Society for Endoscopic Surgery. Nationwide survey on endoscopic surgery in Japan [J]. J Jpn Soc Endosc Surg, 2004, 9(7): 495500.
  7. 7. Japan Society for Endoscopic Surgery. Nationwide survey on endoscopic surgery in Japan [J]. J Jpn Soc Endosc Surg, 2008, 5(5): 525529.
  8. 8. 鄭民華, 臧潞. 腹腔鏡外科治療早期胃癌的現(xiàn)狀 [J]. 內(nèi)科理論與實(shí)踐, 2010, 5(3): 203206.
  9. 9. Goh PM, Khan AZ, So JB, et al. Early experience with laparoscopic radical gastrectomy for advanced gastric cancer [J]. Surg Laparosc Endosc Percutan Tech, 2001, 11(2): 8387.
  10. 10. Sarela AI. Entirely laparoscopic radical gastrectomy for adenocarcinoma: lymph node yield and resection margins [J]. Surg Endosc, 2009, 23(1): 153160.
  11. 11. Japanese Gastric Cancer Association. Guidelines for the treatment of gastric cancer [M]. 2nd. Eds. Tokyo: Kanehara, 2004: 4042.
  12. 12. Japanese Gastric Cancer Association. Guidelines for the treatment of gastric cancer [M]. 3rd. Eds. Tokyo: Kanehara, 2010: 3031.
  13. 13. 胡祥. 日本《胃癌治療指南》(第3版)解讀 [J]. 中國(guó)實(shí)用外科雜志, 2010, 30(1): 2530.
  14. 14. 余佩武. 胃癌腹腔鏡手術(shù)現(xiàn)狀 [J]. 臨床外科雜志, 2008, 16(10): 654656.
  15. 15. Ly QP, Sasson AR. Modern surgical considerations for gastric cancer [J]. J Natl Compr Netw, 2008, 6(9): 885894.
  16. 16. Memon MA, Khan S, Yunus RM, et al. Metaanalysis of laparoscopic and open distal gastr ectomy for gastric carcinoma [J]. Surg Endosc, 2008, 22(8): 17811789.
  17. 17. Park JM, Jin SH, Lee SR, et al. Complications with laparoscopically assisted gastrectomy: multivariate analysis of 300 consecutive cases [J]. Surg Endosc, 2008, 22(10): 21332139.
  18. 18. 余佩武. 腹腔鏡胃癌根治術(shù)的原則與評(píng)價(jià) [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009, 16(1): 15.
  19. 19. Lee JH, Han HS, Lee JH. A prospective randomized study comparing open vs laparoscopyassisted distal gastrectomy in early gastric cancer: early results [J]. Surg Endosc, 2005, 19(2): 168173.
  20. 20. Weber KJ, Reyes CD, Gagner M, et al. Comparison of laparoscopic and open gastrectomy for malignant disease [J]. Surg Endosc, 2003, 17(6): 968971.
  21. 21. Lee SI, Choi YS, Park DJ, et al. Comparative study of laparoscopyassisted distal gastrectomy and open distal gastrectomy [J]. J Am Coll Surg, 2006, 202(6): 874880.
  22. 22. Tanimura S, Higashino M, Fukunaga Y, et al. Laparoscopic gastrectomy for gastric cancer: experience with more than 600 cases [J]. Surg Endosc, 2008, 22(5): 11611164.
  23. 23. Huscher CG, Mingoli A, Sgarzini G, et al. Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: fiveyear results of a randomized prospective trial [J]. Ann Surg, 2005, 241(2): 232237.
  24. 24. Hosono S, Arimoto Y, Ohtani H, et al. Metaanalysis of shortterm outcomes after laparoscopicassisted distal gastrectomy [J]. World J Gastroenterol, 2006, 12(47): 76767683.
  25. 25. Kim HH, Hyung WJ, Cho GS, et al. Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report-a phase Ⅲ multicenter, prospective, randomized Trial (KLASS Trial) [J]. Ann Surg, 2010, 251(3): 417420.
  26. 26. 余佩武, 錢(qián)鋒, 羅華星, 等. 腹腔鏡胃癌根治術(shù)的臨床療效 [J]. 中華消化外科雜志, 2008, 7(1): 3840.
  27. 27. Kitano S, Shiraishi N, Uyama I, et al. A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan [J]. Ann Surg, 2007, 245(1): 6872.
  28. 28. 臧潞, 胡偉國(guó), 李佑, 等. 腹腔鏡早期胃癌根治術(shù)后臨床研究 [J]. 內(nèi)科理論與實(shí)踐, 2010, 5(3): 210213.
  29. 29. Ryu KW, Kim YW, Lee JH, et al. Surgical complications and the risk factors of laparoscopyassisted distal gastrectomy in early gastric cancer [J]. Ann Surg Oncol, 2008, 15(6): 16251631.
  30. 30. 錢(qián)峻, 湯黎明, 朱杰, 等. 腹腔鏡胃癌根治手術(shù)中的團(tuán)隊(duì)配合 [J]. 中國(guó)微創(chuàng)外科雜志, 2009, 9(9): 781783.
  31. 31. 吳濤, 李國(guó)新, 丁自海, 等. 腹腔鏡下遠(yuǎn)端胃癌根治術(shù)中胃背系膜及系膜間隙的解剖形態(tài)特點(diǎn) [J]. 中國(guó)臨床解剖學(xué)雜志, 2007, 25(3): 251254.
  32. 32. Ogura G, Nakamura R, Muragaki Y, et al. Development of an articulating ultrasonically activated device for laparoscopic surgery [J]. Surg Endosc, 2009, 23(9): 21382142.
  33. 33. Oz BS, Mataraci I, Iyem H, et al. Comparison of ultrasonically activated scalpel and traditional technique in radical artery harvesting: clinical research [J]. Thorac Cardiovasc Surg, 2007, 55(2): 104107.
  34. 34. 鄭勇斌, 童仕倫, 譚海燕, 等. 超聲刀在腹腔鏡胃癌根治手術(shù)中的應(yīng)用 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009, 16(10): 781784.
  35. 35. Tokunaga M, Hiki N, Fukunaga T, et al. Quality control and educational value of laparoscopyassisted gastrectomy in a highvolume center [J]. Surg Endosc, 2009, 23(2): 289291.
  36. 36. Pugliese R, Maggioni D, Sansonna F, et al. Total and subtotal laparoscopic gastrectomy for adenocarcinoma [J]. Surg Endosc, 2007, 21(1): 2127.
  37. 37. Lee JH, Kim YW, Ryu KW, et al. A phaseⅡ clinical trial of laparoscopyassisted distal gastrectomy with D2 lymph node dissection for gastric cancer patients [J]. Ann Surg Oncol, 2007, 14(11): 31483153.
  38. 38. Hao YX, Yu PW, Zhong H, et al. Comparison of laparoscopic and open gastrectomy on cancer cells exfoliating from the cancerinvaded serosa [J]. Surg Laparosc Endosc Percutan Tech, 2009, 19(3): 201207.
  39. 39. 陳凜. 腹腔鏡胃癌根治術(shù)后并發(fā)癥的預(yù)防及處理　 [J/OL]. 中華普外科手術(shù)學(xué)雜志(電子版), 2008, 2(1): 2627.
  40. 40. 李佑, 王明亮. 早期胃癌的腹腔鏡手術(shù)治療進(jìn)展　 [J/OL]. 中華腔鏡外科雜志(電子版), 2008, 1(2): 119122.
  41. 41. Varela JE, Hiyashi M, Nguyen T, et al. Comparison of laparoscopic and open gastrectomy for gastric cancer [J]. Am J Surg, 2006, 192(6): 837842.
  42. 42. 松井 英男. 食道空腸順蠕動(dòng)側(cè)側(cè)吻合口法(胃全摘後 RouxenY食道空腸側(cè)側(cè)吻合) [J]. 手術(shù), 2010, 64(10): 14551460.