目的總結(jié)完全腹腔鏡下進(jìn)展期胃癌根治術(shù)的臨床體會(huì)。方法回顧性分析我科2005年8月至2010年5月期間對(duì)26例進(jìn)展期胃癌患者行完全腹腔鏡遠(yuǎn)端胃癌根治術(shù)的臨床資料。結(jié)果所有患者均成功在腹腔鏡下完成整個(gè)手術(shù),無(wú)中轉(zhuǎn)開腹。手術(shù)時(shí)間為270~450 min,(283.2±27.6) min; 術(shù)中出血為80~350 ml,(178.4±67.4) ml。術(shù)后患者胃腸功能恢復(fù)時(shí)間為2~4 d,(2.8±1.2) d; 下床活動(dòng)時(shí)間為1~3 d,(1.5±0.4) d; 進(jìn)流質(zhì)飲食時(shí)間為3~4 d,(3.5±1.4) d; 術(shù)后住院時(shí)間為7~13 d,(10.0±2.6) d 。清掃淋巴結(jié)為11~34枚,(17.8±7.3)枚。所有病例切緣均為陰性,近端切緣與腫瘤距離為5~12 cm,(7.0±2.1) cm; 遠(yuǎn)端切緣與腫瘤距離為4~8 cm,(5.5±1.8) cm。術(shù)后所有患者均獲隨訪,時(shí)間為3~48個(gè)月,平均18.5個(gè)月,2例低分化腺癌患者分別于術(shù)后13和 18個(gè)月復(fù)發(fā)并轉(zhuǎn)移死亡,其余患者未發(fā)現(xiàn)復(fù)發(fā)、轉(zhuǎn)移。結(jié)論完全腹腔鏡下遠(yuǎn)端胃癌根治術(shù)是安全、可行的,但其優(yōu)越性相對(duì)于開腹手術(shù)尚需大量的臨床資料來(lái)證明。
引用本文: 康博雄,王琛,李徐生,樊勇,伏潔. 完全腹腔鏡下進(jìn)展期遠(yuǎn)端胃癌根治術(shù)的臨床體會(huì)(附26例報(bào)道). 中國(guó)普外基礎(chǔ)與臨床雜志, 2011, 18(9): 966-968. doi: 復(fù)制
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- 1. Varela JE, Hiyashi M, Nguyen T, et al. Comparison of laparoscopic and open gastrectomy for gastric cancer [J]. Am J Surg, 2006, 192(6): 837842.
- 2. 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): 15..
- 3. Suh SH, Kwon HC, Jo JH, et al. Oxaliplatin with biweekly low dose leucovorin and bolus and continuous infusion of 5fluorouracil (modified FOLFOX4) as a salvage therapy for patients with advanced gastric cancer [J]. Cancer Res Treat, 2005, 37(5): 279283.
- 4. Cavanna L, Artioli F, Codignola C, et al. Oxaliplatin in combination with 5fluorouracil (5FU) and leucovorin (LV) in patients with metastatic gastric cancer (MGC) [J]. Am J Clin Oncol, 2006, 29(4): 371375.
- 5. Nardi M, Azzarello D, Maisano R, et al. FOLFOX4 regimen as fistline chemotherapy in elderly patients with advanced gastric cancer: a safety study [J]. J Chemother, 2007, 19(1): 8589.
- 6. Nakajima T. Gastric cancer treatment guidelines in Japan [J]. Gastric Cancer, 2002, 5(1): 15.
- 7. 中華醫(yī)學(xué)會(huì)外科分會(huì)腹腔鏡與內(nèi)鏡外科學(xué)組. 腹腔鏡胃惡性腫瘤手術(shù)操作指南(2007年版)[J]. 外科理論與實(shí)踐, 2007, 12(6): 610614..
- 8. Sarela AI. Entirely laparoscopic radical gastrectomy for adenocarcinoma: lymph node yield and resection margins [J]. Surg Endosc, 2009, 23(1): 153160.
- 9. 余佩武. 腹腔鏡胃癌手術(shù)的進(jìn)展與展望 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2011, 18(2): 105109..
- 10. 李國(guó)新, 張策, 余江. 腹腔鏡輔助遠(yuǎn)端胃癌D2根治術(shù): 基于解剖的藝術(shù) [J]. 外科理論與實(shí)踐, 2007, 12(6): 533538..
- 11. 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): 781784..
- 12. Mohri Y, Tonouchi H, Tanaka K, et al. Ultrasonically activated shears in gastrectomy for large gastric cancers [J]. Surg Today, 2007, 37(12): 10601063.
- 13. 蘭晶, 管洪庚, 秦磊, 等. 腹腔鏡輔助與開腹胃癌根治術(shù)治療進(jìn)展期胃癌中的效果比較[J]. 中華實(shí)驗(yàn)外科雜志, 2010, 27(12): 19331936..
- 14. 鄭民華, 藏路. 腹腔鏡胃癌根治術(shù)的現(xiàn)狀[J]. 腹腔鏡外科雜志, 2010, 15(3): 161163..