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目的:探讨腹腔镜胃癌根治术在早期胃癌治疗中的临床应用。方法:回顾性分析2004年10月至2009年12月间79例接受腹腔镜胃癌根治术的早期胃癌患者的临床资料,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:除1例中转开腹手术外,其余78例均在腹腔镜下完成胃切除和淋巴结清扫,其中腹腔镜远端胃切除术74例,近端胃切除术2例,全胃切除术2例;腹腔镜下D1+α式淋巴结清扫34例,D1+β式淋巴结清扫15例,D2式淋巴结清扫29例。手术时间为(202.9±45.6)min,术中失血(144.5±146.5)mL,术后排气时间(2.8±1.0)d,术后住院天数为(11.3±5.6)d,8例(10.1%)患者出现腹腔内出血、吻合口漏、小肠梗阻等,经手术和非手术治疗后痊愈。手术上、下切缘距离肿瘤为(4.0±1.9)cm和(3.6±1.7)cm,手术平均清扫淋巴结(13.1±6.5)枚,其中有3例(3.8%)发现淋巴结转移。术后随访2～64个月,均无肿瘤复发和远处转移。结论:腹腔镜胃癌根治术是治疗早期胃癌安全、可行、微创、有效的手术方法。
Objective: To investigate the clinical application of laparoscopic radical gastrectomy in the treatment of early gastric cancer. Methods: The clinical data of 79 patients with early stage gastric cancer undergoing laparoscopic radical gastrectomy from October 2004 to December 2009 were analyzed retrospectively. The clinical data including operation method, operation time, intraoperative blood loss, postoperative exhaust time, Length of stay, complications, postoperative pathology and follow-up. Results: In addition to 1 case of laparotomy, the remaining 78 cases were performed laparoscopic gastrectomy and lymph node dissection, of which laparoscopic distal gastrectomy in 74 cases, proximal gastrectomy in 2 cases, total gastrectomy 2 Cases; laparoscopic D1 + α-type lymph node dissection in 34 cases, D1 + β-type lymph node dissection in 15 cases, D2-type lymph node dissection in 29 cases. The operative time was (202.9 ± 45.6) min, blood loss was (144.5 ± 146.5) mL, postoperative exhaust time was 2.8 ± 1.0 days, postoperative hospital stay was (11.3 ± 5.6) days and 8 cases (10.1% Patients with intra-abdominal hemorrhage, anastomotic leakage, intestinal obstruction, etc., after surgery and non-surgical treatment recovered. The average tumor size was 4.0 ± 1.9 cm and 3.6 ± 1.7 cm, and the average number of lymph nodes was 13.1 ± 6.5. Among them, 3 cases (3.8%) had lymph node metastases. All cases were followed up for 2 to 64 months without any tumor recurrence and distant metastasis. Conclusions: Laparoscopic radical gastrectomy is a safe, feasible, minimally invasive and effective surgical method for early gastric cancer.