[1]方钱,王卫军,李剑锋,等.腹腔镜在胃恶性肿瘤中的应用[J].中国微创外科杂志,2011,11(5):395-397.
　Fang Qian,Wang Weijun,Li Jianfeng,et al.Laparoscopy for the Treatment of Malignant Gastric Tumor[J].Chinese Journal of Minimally Invasive Surgery,2011,11(5):395-397.
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腹腔镜在胃恶性肿瘤中的应用()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
11
期数:
2011年5期
页码:
395-397
栏目:
出版日期:
2011-05-20

文章信息/Info

Title:
Laparoscopy for the Treatment of Malignant Gastric Tumor
作者:
方钱; 王卫军; 李剑锋; 金鹏飞; 李智涛; 李嘉根; 陈军政
浙江省温岭市第一人民医院微创外科医学中心温州医学院附属温岭医院微创外科医学中心，温岭317500
Author(s):
Fang Qian;  Wang Weijun;  Li Jianfeng;  et al.
Medical Center of Minimal Invasive Surgery, Wenling First People’s Hospital, Wenling 317500, China
关键词:
腹腔镜; 胃切除; 胃恶性肿瘤
Keywords:
Laparoscopy; Gastrectomy; Malignant gastric tumor
分类号:
R730.56
文献标志码:
A
摘要:
目的探讨腹腔镜在胃恶性肿瘤中应用的安全性及可行性。方法2005年9月~2010年6月，27例早期及进展期胃癌行腹腔镜辅助下根治性胃切除术，其中根治性全胃切除术2例，近端胃大部切除术6例，近端胃联合脾脏切除术1例，远端胃大部切除术18例。术区及切口用氟尿嘧啶（5FU）蒸馏水冲洗，术后TNM分期Ⅱ期及以上予奥沙利铂联合亚叶酸钙和5FU（FOLFOX）方案化疗。结果27例腹腔镜辅助胃部分及全胃切除均成功，无中转开腹手术。淋巴结清扫范围D1清扫8例，D2 19例。全胃切除、近端胃切除、远端胃切除、近端胃切除联合脾切除手术时间分别为240和370 min、260~390（338±126）min、220~350（276±95）min、350 min，术中出血分别为180和230 ml、50~260（138±80）ml、80~300（112±76）ml、250 ml。清扫淋巴结分别为30和45枚、25~38（30±9）枚、21~43(31±11)枚、40枚。术后胃肠功能恢复时间分别为4和5 d、2~5(4.5±1.4)d、3~5(4.1±1.0)d、5 d，下床活动时间分别4和5 d、3~5(3.5±1.1)d、2~5(3.2±1.0)d、6 d，进流质时间为6和7 d、5~8(6.2±1.3)d、4~7(5.9±1.1)d、7 d，术后住院时间分别为10和12 d、9~11(9.2±1.1)d、7~12(8.2±1.3)d、12 d。术后TNM分期：Ⅰ期3例，Ⅱ期10例，ⅢA期9例，ⅢB期5例。23例术后随访4~57个月，平均26个月，其中16例＞12个月。7例死亡，术后生存9~52个月，平均32个月。结论腹腔镜胃癌根治术安全、可行，具有创伤小、术后恢复快等优点。
Abstract:
ObjectiveTo evaluate the feasibility and safety of laparoscopy in the treatment of malignant gastric tumor.MethodsFrom September 2005 to June 2010, we performed laparoscopicassisted gastrectomy on 27 patients with gastric cancer in early or advanced stage. The procedure included radical gastrectomy in 2, proximal subtotal gastrectomy in 6, proximal subtotal gastrectomy combined with splenectomy in 1, and distal subtotal gastrectomy in 18. 5FU and distilled water were used to wash surgical area and incision. After the operation, we used FOLFOX regimen for chemotherapy in patients with TNM stage Ⅱ tumors.ResultsThe procedures were completed successfully in all the 27 patients without conversion to open surgery. D1 lymph node dissection was carried out in 8 cases and D2 in other 19. In the groups of radical gastrectomy, proximal subtotal gastrectomy, distal subtotal gastrectomy, and proximal subtotal gastrectomy combined with splenectomy, the mean operation time was 240 min and 370 min, (338±126) min (range, 260-390 min), (276±95) min (range, 220-350 min) and 350 min, respectively; mean blood loss during the procedure was 180 ml and 230 ml, 138±80 (50-260) ml, 112±76 (80-300) ml, and 250 ml; total number of resected lymph nodes was 30 and 45, 30±9 (25-38), 31±11 (21-43), and 40; and gastrointestinal recovery time was 4 and 5, 4.5±1.4 (2-5), 4.1±1.0 (3-5), and 5 days, respectively. They recovered normal activity in a mean of 4 and 5, 3.5±1.1 (3-5), 3.2±10 (2-5), and 6 days, and received liquid food in 6, 7, 6.2±1.3 (5-8), 5.9±1.1 (4-7), and 7 days respectively. The patients were discharged form hospital in a mean of 10 and 12, 9.2±1.1 (9-11), 8.2±1.3 (7-12) and 12 days, respectively. Postoperative TNM staging showed stage Ⅰ in 3, Ⅱ in 10, ⅢA in 9, and ⅢB in 5. Followup was achieved in 23 of the patients for 4 to 57 months with a mean of 26 months (over 12 months in 16 cases). Seven patients died during the period in 9 to 52 months (mean, 32 months).ConclusionLaparoscopicassisted gastrectomy is a feasible and safe surgical procedure with minimal invasion and quick recovery.

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备注/Memo

备注/Memo:
基金项目：浙江省医药卫生科学资助基金（浙卫2009A228），浙江省温岭市科技局科技项目（2010WLCA0049）王卫军通讯作者，Email：wwj5558@yahoo.com.cn
更新日期/Last Update: 2013-04-18