腹腔镜下近端胃切除术治疗近端早期胃癌
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李福广, Email: aklifg@163.com

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Laparoscopy-assisted proximal gastrectomy for early-stage proximal gastric cancer
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    摘要:

    目的:探讨腹腔镜下近端胃切除术治疗近端早期胃癌的可行性与安全性。方法:回顾性分析2007年6月—2010年12月间手术治疗的72例近端早期胃癌患者资料,其中38例行腹腔镜下近端胃切除术(LAPG组),34例行腹腔镜下胃大部切除术(LAG组)。比较两组患者的一般情况、术中与术后各项指标,并用Visick评分比较两组患者术后胃食管反流症状。结果:两组患者年龄、性别、体质量指数、并存疾病、手术时间及术后住院天数差异均无统计学意义(均P>0.05),但LAPG组术中出血量明显少于LAG组(P<0.05)。两组患者术后肛门排气时间、开始进食时间及早、晚期并发症发生率差异均无统计学意义(均P>0.05),但LAPG组术后Visick评分明显高于LAG组(P<0.05)。两组患者术后病理指标、手术前后的营养学指标变化、术后生存率差异均无统计学意义(均P>0.05)。结论:腹腔镜下近端胃切除术能够安全的应用于近端早期胃癌的治疗,但应警惕术后胃食管反流症状的发生。

    Abstract:

    Objective: To evaluate feasibility and safety of laparoscopy-assisted proximal gastrectomy in treatment of early-stage proximal gastric cancer. Methods: The clinical data of 72 patients with early-stage proximal gastric cancer undergoing surgical treatment from June 2007 to December 2010 were retrospectively analyzed. Of the patients, 38 cases underwent laparoscopy-assisted proximal gastrectomy (LAPG group) and laparoscopy-assisted subtotal gastrectomy (LAG group). The general conditions, intra- and postoperative variables were compared, and the symptoms of gastroesophageal reflux after surgery between the two groups were also compared by using Visick score. Results: No significant difference was noted in age, gender, body mass index, concomitant disease, operative time and length of postoperative hospital stay between the two groups (all P>0.05), but the intraoperative blood loss in LAPG group was significantly reduced compared with LAG group (P<0.05). The time to first postoperative flatus and food intake, and incidence of early and delayed complications after surgery showed no significant difference between the two groups (all P>0.05), but the postoperative Visick score in LAPG group was significantly higher than that in LAG group (P<0.05). The postoperative pathological parameters, pre- and postoperative changes in nutritional parameters and postoperative survival rate between the two groups showed no significant difference (all P>0.05). Conclusion: laparoscopy-assisted proximal gastrectomy can be safely used in treatment of early proximal gastric cancer and however, the occurrence of postoperative gastroesophageal reflux should be monitored carefully.

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金鑫,李福广,李立,冯利,王宁.腹腔镜下近端胃切除术治疗近端早期胃癌[J].中国普通外科杂志,2015,24(4):560-564.
DOI:10.3978/j. issn.1005-6947.2015.04.018

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  • 收稿日期:2014-05-18
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  • 在线发布日期: 2015-04-15