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目的:探讨腹腔镜辅助胃癌根治术治疗早期和进展期胃癌的临床价值。方法:回顾2004年2月至2010年12月上海交通大学医学院附属瑞金医院外科收治的209例行腹腔镜辅助胃癌根治术胃癌病人的临床和手术资料。结果:腹腔镜辅助远端胃切除术170例,近端胃切除术9例,全胃切除术30例;腹腔镜下D1+α淋巴结清扫37例,D1+β淋巴结清扫32例,D2淋巴结清扫140例。手术时间为(218.3±54.4)min,术中出血量为(201.2±188.1)mL。手术近、远端切缘距离为(4.5±2.0)cm和(4.6±2.1)cm,淋巴结清扫数目为(19.1±9.7)枚。早期胃癌和进展期胃癌淋巴结获取数分别为(16.4±8.4)枚和(21.9±10.2)枚。25例(11.9%)病人发生吻合口漏、腹腔内出血、小肠梗阻等并发症。根据术后病理分期:ⅠA期病人100例(47.8%),ⅠB期病人21例(10.0%),ⅡA期病人8例(3.8%),ⅡB期病人31例(14.8%),ⅢA期病人13例(6.2%),ⅢB期病人18例(8.7%),ⅢC期病人18例(8.7%),中位随访时间31(2~60)个月,死亡率15.8%(33/209),肿瘤复发率16.3%(34/209),病人5年总体生存率80.9%,5年无病生存率79.6%。结论:腹腔镜辅助胃癌根治术治疗进展期胃癌,与早期胃癌一样安全可行,具有创伤小、术后恢复快等优点,能达到肿瘤根治目的。
Objective: To investigate the clinical value of laparoscopic-assisted radical gastrectomy in the treatment of early and advanced gastric cancer. Methods: The clinical and surgical data of 209 patients undergoing laparoscopic radical gastrectomy for gastric cancer admitted from February 2004 to December 2010 in Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine were retrospectively reviewed. Results: Laparoscopic assisted distal gastrectomy was performed in 170 cases, proximal gastrectomy in 9 cases and total gastrectomy in 30 cases. Laparoscopic D1 + α lymph node dissection in 37 cases, D1 + β lymph node dissection in 32 cases, D2 lymph node dissection 140 cases. The operation time was (218.3 ± 54.4) min and the blood loss was (201.2 ± 188.1) mL. The distance of the distal incision was (4.5 ± 2.0) cm and (4.6 ± 2.1) cm, and the number of lymph node dissection was (19.1 ± 9.7) mm. The numbers of lymph nodes in early gastric cancer and advanced gastric cancer were (16.4 ± 8.4) and (21.9 ± 10.2), respectively. 25 patients (11.9%) patients with anastomotic leakage, intra-abdominal bleeding, intestinal obstruction and other complications. According to the postoperative pathological staging, 100 patients (47.8%) were in stage IA, 21 (10.0%) in stage IB, 8 (3.8%) in stage IIA, 31 (14.8%) in stage IIB, 18 cases (8.7%) were in stage ⅢB disease, 18 cases (8.7%) were in stage ⅢC disease, with a median follow-up time of 31 (2-60) months and a mortality rate of 15.8% (33/209) The recurrence rate was 16.3% (34/209). The 5-year overall survival rate was 80.9% and the 5-year disease-free survival rate was 79.6%. Conclusions: Laparoscopic-assisted radical gastrectomy for advanced gastric cancer is as safe and feasible as early gastric cancer with the advantages of less trauma and faster postoperative recovery, which can achieve the goal of radical tumor therapy.