Fujiwara Michitaka, Kodera Yasuhiro, Kasai Yasushi, Kanyama Yasuaki, Hibi Kenji, Ito Katsuki, Akiyama Seiji, Nakao Akimasa
Department of Surgery II, Nagoya University School of Medicine, Nagoya/Aichi, Japan.
J Am Coll Surg. 2003 Jan;196(1):75-81. doi: 10.1016/s1072-7515(02)01539-9.
Recently, laparoscopy and laparoscopy-assisted surgery have been used increasingly as less-invasive alternatives to conventional open surgery. But the use of this approach in gastric carcinoma has received little attention, possibly from the low incidence of early-stage disease in the West and the relative complexity of the surgical procedure.
A prospective feasibility study of laparoscopy-assisted distal gastrectomy was performed in patients with histologically confirmed gastric carcinoma located in the lower or middle third of the stomach. Patients whose preoperative evaluations, including endoscopic ultrasonography and computerized tomography, led to a diagnosis of T1 N0 stage disease, and who had no advanced disease discovered during laparoscopy, were eligible. Intraoperative blood loss, time of operation, mortality, and morbidity were assessed, along with the number of lymph nodes retrieved and shortterm survival.
Between 1998 and 1999, 43 patients were enrolled. Laparoscopy-assisted distal gastrectomy was converted to an open procedure in one patient. There were no operative or in-hospital deaths, but the incidence of anastomotic leakage was 14% (6 of 43). The mean blood loss was 239 mL, the time of operation was 225 minutes, and lymph node retrieval was 20.2 nodes. These results are comparable with a series of conventional open operations. One patient died of recurrent disease, and all other patients remain disease-free to date. Port-site recurrence was not observed.
Although laparoscopy-assisted distal gastrectomy was equivalent to open surgery in several clinical parameters, the relatively high morbidity was a drawback. Its appropriateness to gastric cancer surgery must be verified by further studies.
近来，腹腔镜及腹腔镜辅助手术作为传统开放手术的微创替代方法，其应用日益增多。但该方法在胃癌治疗中的应用鲜受关注，这可能是由于西方国家早期胃癌发病率较低以及手术操作相对复杂。
对组织学确诊为胃中下部癌的患者进行腹腔镜辅助远端胃切除术的前瞻性可行性研究。术前评估（包括内镜超声和计算机断层扫描）诊断为T1 N0期疾病且腹腔镜检查未发现晚期疾病的患者符合入选标准。评估术中失血量、手术时间、死亡率、发病率，以及获取的淋巴结数量和短期生存率。
1998年至1999年间，共纳入43例患者。1例患者的腹腔镜辅助远端胃切除术转为开放手术。无手术死亡或住院死亡，但吻合口漏发生率为14%（43例中的6例）。平均失血量为239毫升，手术时间为225分钟，获取淋巴结20.2枚。这些结果与一系列传统开放手术相当。1例患者死于复发性疾病，其他所有患者至今无病生存。未观察到切口部位复发。
尽管腹腔镜辅助远端胃切除术在一些临床参数上与开放手术相当，但相对较高的发病率是一个缺点。其在胃癌手术中的适用性必须通过进一步研究加以验证。
