中华胃肠外科杂志
中華胃腸外科雜誌
중화위장외과잡지
CHINESE JOURNAL OF GASTROINTESTINAL SURGERY
2013年
10期
970-973
,共4页
曹永宽%刘立业%龚加庆%王永华%罗国德%周均%干伟%黄岭
曹永寬%劉立業%龔加慶%王永華%囉國德%週均%榦偉%黃嶺
조영관%류립업%공가경%왕영화%라국덕%주균%간위%황령
胃肿瘤%胃癌根治术%D2淋巴结清扫%手辅助腹腔镜
胃腫瘤%胃癌根治術%D2淋巴結清掃%手輔助腹腔鏡
위종류%위암근치술%D2림파결청소%수보조복강경
Stomach neoplasms%Radical gastrectomy%D2 lymphadenectomy%Hand-assisted laparoscopy
目的 探讨手辅助腹腔镜胃癌D2根治术中的淋巴结清扫模式.方法 回顾性分析成都军区总医院全军普通外科中心胃肠外科2010年12月至2012年9月间,采用自行设计的手术操作系统所实施的111例手辅助腹腔镜胃癌D2根治术患者的临床资料.患者均采用自左向右、伴随肿瘤一并完整切除的淋巴结清扫模式(逆向卷席式淋巴结清扫模式),即手辅助腹腔镜下完成胃近端区域淋巴结清扫后,在预切除线切断胃或食管,将切除组织移出腹腔外,在直视下完成其他区域的淋巴结清扫,完整切除肿瘤组织,最后进行消化道重建.结果 全组患者手术切口长度(6.8±0.3)cm；术中出血量(238.4±113.6)ml;手术时间(171.9±23.3)min.手术切缘残端均无癌残留,病理检获淋巴结数(17.2±5.7)枚/例.术后并发症10例(9.0％),围手术期死亡1例(0.9％)；术后住院时间(10.1±3.7)d.结论 逆向卷席式淋巴结清扫模式可以避免开腹与腹腔镜手术模式的多次转换,有利于手辅助腹腔镜胃癌D2根治术操作流程的标准化.
目的 探討手輔助腹腔鏡胃癌D2根治術中的淋巴結清掃模式.方法 迴顧性分析成都軍區總醫院全軍普通外科中心胃腸外科2010年12月至2012年9月間,採用自行設計的手術操作繫統所實施的111例手輔助腹腔鏡胃癌D2根治術患者的臨床資料.患者均採用自左嚮右、伴隨腫瘤一併完整切除的淋巴結清掃模式(逆嚮捲席式淋巴結清掃模式),即手輔助腹腔鏡下完成胃近耑區域淋巴結清掃後,在預切除線切斷胃或食管,將切除組織移齣腹腔外,在直視下完成其他區域的淋巴結清掃,完整切除腫瘤組織,最後進行消化道重建.結果 全組患者手術切口長度(6.8±0.3)cm；術中齣血量(238.4±113.6)ml;手術時間(171.9±23.3)min.手術切緣殘耑均無癌殘留,病理檢穫淋巴結數(17.2±5.7)枚/例.術後併髮癥10例(9.0％),圍手術期死亡1例(0.9％)；術後住院時間(10.1±3.7)d.結論 逆嚮捲席式淋巴結清掃模式可以避免開腹與腹腔鏡手術模式的多次轉換,有利于手輔助腹腔鏡胃癌D2根治術操作流程的標準化.
목적 탐토수보조복강경위암D2근치술중적림파결청소모식.방법 회고성분석성도군구총의원전군보통외과중심위장외과2010년12월지2012년9월간,채용자행설계적수술조작계통소실시적111례수보조복강경위암D2근치술환자적림상자료.환자균채용자좌향우、반수종류일병완정절제적림파결청소모식(역향권석식림파결청소모식),즉수보조복강경하완성위근단구역림파결청소후,재예절제선절단위혹식관,장절제조직이출복강외,재직시하완성기타구역적림파결청소,완정절제종류조직,최후진행소화도중건.결과 전조환자수술절구장도(6.8±0.3)cm；술중출혈량(238.4±113.6)ml;수술시간(171.9±23.3)min.수술절연잔단균무암잔류,병리검획림파결수(17.2±5.7)매/례.술후병발증10례(9.0％),위수술기사망1례(0.9％)；술후주원시간(10.1±3.7)d.결론 역향권석식림파결청소모식가이피면개복여복강경수술모식적다차전환,유리우수보조복강경위암D2근치술조작류정적표준화.
Objective To summarize the experience of lymph node dissection patterns in handassisted laparoscopic radical gastrectomy.Methods One hundred and eleven patients with gastric carcinoma between December 2010 and September 2012 were operated by hand-assisted laparoscopic system designed by us.Clinical data were analyzed retrospectively.The lymph nodes were dissected from left to right together with total tumor resection(reverse lymph nodes scavenge pattern),then digestive tract was reconstructed.Results Total gastrectomy,distal gastrectomy and proximal gastrectomy were performed in 57,46 and 8 cases respectively.Combined cholecystectomy and lateral segment of left liver lobe were needed in 4 and 2 patients respectively,and 1 case underwent combined splenectomy and pancreatic body and tail resection.TNM staging of patients in Ⅰ,Ⅱ,Ⅲ A,ⅢB,and Ⅳ were 16,8,35,14,and 38,respectively.Histological type was poorly differentiated in 78 cases,moderate differentiation in 26 cases and good differentiation in 7 cases.The incision length was(6.8±0.3)cm,blood loss was(238.4±113.6)ml,operative time was(171.9±23.3)min,number of removed lymph node was 17.2±5.7,hospital stay was(10.1±3.7)d,postoperative complication rate was 9.0％.One case died during perioperative time.Conclusions Hand-assisted laparoscopic D2 radical gastrectomy(reverse lymph nodes scavenge pattern)can avoid the multiple conversion of open-laparoscopic operation model,and is beneficial to the standardization for surgical procedure.
