CAJ | 학술논문

目的评价完全腹腔镜胃癌根治术(TLG)的可行性和临床疗效.方法对2007年3月至2009年4月在浙江大学医学院附属邵逸夫医院进行TLG的37例患者的临床资料进行同顾性分析.37例中男23例,女14例;年龄44～79岁,平均62岁.术前影像学检查除外远处转移、周围脏器侵犯、主要血管受累及腹膜后多发淋巴结转移.结果 37例均顺利完成TLG,无一例中转开腹手术或腹腔镜辅助手术.远端胃大部切除29例,全部采用毕Ⅱ式胃肠吻合;全胃切除8例,其中食管空肠端侧吻合5例,食管空肠侧侧吻合3例.19例辅以术中胃镜定位.手术时间210～355 min,平均(284±43)min.术中出血80-450 ml,平均(175±62)ml.清扫淋巴结18～55枚,平均(31±9)枚.术后肺部感染1例,对症治疗后痊愈;短期胃排空障碍1例,胃肠减压治疗6 d后痊愈.无围手术期死亡.术后住院时间6～14 d,平均(9±2)d.术后随访2～25个月,未见复发.结论对于有丰富腹腔镜手术经验的术者,TLG是安全可行的.TLG近期疗效良好,而且更符合微创手术理念和肿瘤手术的无瘤操作原则.
목적 평개완전복강경위암근치술(TLG)적가행성화림상료효.방법 대2007년3월지2009년4월재절강대학의학원부속소일부의원진행TLG적37례환자적림상자료진행동고성분석.37례중남23례,녀14례;년령44～79세,평균62세.술전영상학검사제외원처전이、주위장기침범、주요혈관수루급복막후다발림파결전이.결과 37례균순리완성TLG,무일례중전개복수술혹복강경보조수술.원단위대부절제29례,전부채용필Ⅱ식위장문합;전위절제8례,기중식관공장단측문합5례,식관공장측측문합3례.19례보이술중위경정위.수술시간210～355 min,평균(284±43)min.술중출혈80-450 ml,평균(175±62)ml.청소림파결18～55매,평균(31±9)매.술후폐부감염1례,대증치료후전유;단기위배공장애1례,위장감압치료6 d후전유.무위수술기사망.술후주원시간6～14 d,평균(9±2)d.술후수방2～25개월,미견복발.결론 대우유봉부복강경수술경험적술자,TLG시안전가행적.TLG근기료효량호,이차경부합미창수술이념화종류수술적무류조작원칙.
Objective To evaluate the feasibility and clinical efficacy of totally laparoscopic gastrectomy (TLG) for gastric cancer. Methods The investigators retrospectively analyzed 37 cases undergoing TLG for gastric cancer from March 2007 to April 2009 at Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University. Results All 37 cases underwent successful TLG. There was neither transfer to open nor laparoscopic assisted surgery. Twenty-nine cases underwent distal gastrectomy with Billroth Ⅱ reconstruction, 8 cases total gastrectomy with Roux-en-Y reconstruction, including 5 cases with end-to-side esophageal jejunostomy and 3 cases with side-to-side esophageal jejunostomy. Nineteen cases assisted by intraoperative gastroscopy for tumor locating. The operation duration was 210-355 min [mean (284±43) min]. The blood loss was 80-450 ml [mean (175±62) ml]. The number of dissected lymph nodes was 18-55 [mean (31±9) ]. Two cases had post-operative complications, with 1 case of pulmonary infection recovering well after symptomatic treatment and 1 case of temporary delayed gastric emptying recovering well after gastrointestinal decompression for 6 days. No mortality was reported. The hospital stay was 6-14 d [mean (9±2) d]. There was no recurrence during the follow-up period of 2-25 months. Conclusions For surgeons with rich experiences of laparoscopic surgery, TLG for gastric cancer is both safe and feasible. The short-term efficacy of TLG is satisfactory. Furthermore, TLG conforms more to the concept of minimally invasive surgery and the principle of tumor-free technique.