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腹腔镜辅助全胃切除术联合淋巴结清扫治疗胃中上段癌

Laparoscopically assisted total gastrectomy with lymph node dissection for upper and middle gastric cancer.

作者信息

Mochiki Erito, Toyomasu Yoshitaka, Ogata Kyouichi, Andoh Hiroyuki, Ohno Tetsuro, Aihara Ryusuke, Asao Takayuki, Kuwano Hiroyuki

机构信息

Department of General Surgical Science, Faculty of Medicine, Gunma University, Maebashi, Japan.

出版信息

Surg Endosc. 2008 Sep;22(9):1997-2002. doi: 10.1007/s00464-008-0015-9. Epub 2008 Jul 2.

Abstract

BACKGROUND

In recent years, laparoscopic gastrectomy has been applied for the treatment of gastric cancer in Japan and Western countries. This report describes the short- and long-term results for patients with gastric cancer who underwent laparoscopically assisted total gastrectomy (LATG) with lymph node dissection.

METHODS

From September 1999 to December 2007, 20 patients underwent LATG, and 18 underwent conventional open total gastrectomy (OTG) for upper and middle gastric cancer. The indications for LATG included depth of tumor invasion limited to the mucosa or submucosa and absence of lymph node metastases in preoperative examinations. The LATG and OTG procedures for gastric cancer were compared in terms of pathologic findings, operative outcome, complications, and survival.

RESULTS

No significant difference was found between LATG and OTG in terms of operation time (254 vs 248 min.), number of lymph nodes (26 vs 35), complication rate (25% vs 17%), or 5-year cumulative survival rate (95% vs 90.9%). Differences between LATG and OTG were found with regard to blood loss (299 vs 758 g) and postoperative hospitalization (19 vs 29 days).

CONCLUSION

For properly selected patients, laparoscopically assisted total gastrectomy can be a curative and minimally invasive treatment for early gastric cancer.

摘要

背景

近年来,腹腔镜胃切除术已在日本和西方国家应用于胃癌治疗。本报告描述了接受腹腔镜辅助全胃切除术(LATG)并进行淋巴结清扫的胃癌患者的短期和长期结果。

方法

1999年9月至2007年12月,20例患者接受了LATG,18例因中上段胃癌接受了传统开放性全胃切除术(OTG)。LATG的适应证包括术前检查中肿瘤浸润深度仅限于黏膜或黏膜下层且无淋巴结转移。比较了LATG和OTG治疗胃癌的病理结果、手术结果、并发症和生存率。

结果

LATG和OTG在手术时间(254对248分钟)、淋巴结数量(26对35)、并发症发生率(25%对17%)或5年累积生存率(95%对90.9%)方面无显著差异。LATG和OTG在失血量(299对758克)和术后住院时间(19对29天)方面存在差异。

结论

对于经过适当选择的患者,腹腔镜辅助全胃切除术可以成为早期胃癌的一种根治性且微创的治疗方法。

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