腹腔镜在胃癌根治术中的应用.DOCVIP

临床医学论文-腹腔镜在胃癌根治术中的应用 【摘要】? 目的：探讨腹腔镜胃癌根治术的可行性和效果。方法：分析腹腔镜胃癌根治术１６例患者的临床资料，其中全胃切除术4例,近端胃大部切除术３例，远端胃大部切除术9例。结果：16例均顺利完成腹腔镜手术。手术平均时间：全胃切除术380min(350～410min),近端胃大部切除术236min(210～259min）,远端胃大部切除术273min(250～310min）。术中平均出血量：全胃切除术500ml(400～600ml),近端胃大部切除术120ml(50～170ml),远端胃大部切除术140ml(70～200ml）。术后患者平均胃肠功能恢复时间为3２d(2～４d）,下床活动时间为33d(3～4d）,开始进流质时间３９d（３～５d）,术后近期恢复良好。结论：腹腔镜胃癌根治手术安全、可行，能够达到与开腹手术相当的根治效果。 　　【关键词】? 腹腔镜；胃肿瘤；胃切除术 　　Ｔhe application of laparoscopy in the radical gastrectomy 　　【Abstract】? Ｏbjective:To explore the feasibility,method and effect of laparoscopicallyassisted radical gastrectomy.Methods:In a total of 16 cases gastric cancer,there were 4 cases receiving radical total gastrectomy,3 cases receiving proximal gastrectomy,and 9 cases receiving distal gastrectomy.Results:16 cases underwent laparoscopicallyassisted surgery successfully and there was no conversion to open surgery.The average operative time of total gastrectomy was 380min(250410min),while it was 236min(210259min) in proximal gastrectomy and 273min(250310min) in distal gastrectomy.The average blood loss was 500ml(400６00ml) in total gastrectomy,120ml(50170ml) in proximal gastrectomy,and 140ml(70200ml） in distal gastrectomy.The average time of recovery of bowel function was 3.2d(24d).Time of bedside movement was 3.3d(34d）and the average time of oral intake was 3.9d(35d) after operation.No complication was oberserved.Conclusions:Ｌaparoscopic radical gastrectomy is a safe procedure and matches the results of open surgery.It also leads to less trauma and rapid recovery. 　　【Key words】? Laparoscopy;Stomach neoplasms;Gastrectomy 　　腹腔镜胃癌手术至今尚不普及，主要原因是技术难度大，费用较高以及人们对它的认同程度。我院自2004年12月开始行腹腔镜胃癌根治术,至今己完成16例,近期效果令人满意,现报道如下。 　　1? 资料与方法　　　　11? 临床资料? 本组１６例中男10例,女6例；４６～７３岁，平均６０２岁。肿瘤位于胃底贲门区1例,胃体靠近贲门2例,胃体中部4例,胃角2例,胃窦7例。按TNM分期,I期1例,II期6例,IIIa期5例,IIIb期4例。４例行根治性全胃切除术，其中联合横结肠部分切除术1例,联合右半结肠及横结肠部分切除术１例，联合横结肠部分及右侧卵巢切除术1例。根治性近端胃大部切除术3例,其中联合脾、胰体尾部分切除1例。根治性远端胃大部切除术9例,其中联合横结肠部分切除术1例。 　　１２? 手术方法? 术前准备同常规开腹手术，均气管插管全身麻醉。取平卧位，于脐下缘刺入气腹针,建气