Du Jianjun, Li Jipeng, Li Yongqi, Ji Gang, Yang Zhi, Gao Zhiqing, Zheng Jianyong
Department of General Surgery, Xijing Hospital, Fourth Military Medical University, No.15 Changle West Road, Xian 710032, People's Republic of China.
Hepatogastroenterology. 2008 Sep-Oct;55(86-87):1908-12.
BACKGROUND/AIMS: Conventional open total gastrectomy in patients with IV stage or metastatic gastric carcinoma in the middle or upper third of the stomach is under controversy due to its poor prognosis and its surgical complexity. Based on advances in laparoscopic equipment, techniques, and ongoing experience in laparoscopically- assisted D2 total gastrectomy, laparoscopically-assisted noncurative total gastrectomy was performed in patients with stage IV or metastatic gastric carcinoma in the middle or upper third of the stomach who suffered from local gastric bleeding, pain, obstruction symptoms refractory to other therapies at our institution. The purpose of the current study was to determine feasibility of laparoscopically-assisted noncurative total gastrectomy in patients with stage IV disease or metastatic gastric cancer.
Between July 2005 and Sep 2007 in our institution, 43 patients with stage IV disease or metastatic gastric carcinoma in the middle or upper third of the stomach who suffered from local gastric bleeding, pain, obstruction refractory to other therapies underwent laparoscopically-assisted noncurative total gastrectomy. Stomach was dissected and the first part of the duodenum was transected laparoscopically. Because of extensive involvement of adjacent tissues, final dissection was performed extracorporeally by a small laparotomy incision under the xyphoid (5-7 cm) for removal of specimen and anastomosis. Clinical data of the procedure was analyzed.
None of 43 patients was converted to laparotomy and no operative mortality was observed. Final dissection of involvement was extracorporeally performed by a small laparotomy incision in 18 patients with extensive involvement of adjacent tissues. Postoperative complication occurred in 4 cases (9%), 1 minor duodenal stump leak, 3 wound infection. The mean operative time was 245 +/- 81 min, operative blood loss was 163 +/- 131 mL. Time of ambulation and first flatus were 2.6 +/- 1.3 and 3.3 +/- 1.0 days after surgery respectively. All patients uneventfully recovered after surgery. Mean hospital stay was 8.8 +/- 3.5 days. All preoperative symptoms resolved. Mean survival time was 8.9 +/- 3.2 months, 5 patients still are alive to present within fellow-up of 6-15 months.
Laparoscopically-assisted noncurative total gastrectomy in patients with stage IV or metastatic gastric cancer is considered to be a safe and feasible approach. Laparoscopically-assisted palliative total gastrectomy can be performed to obtain better quality of life in patients with gastric cancer who suffered from local gastric bleeding, pain, obstruction symptoms refractory to other therapies.
背景/目的：对于胃中上部IV期或转移性胃癌患者，传统开放性全胃切除术因其预后较差且手术复杂而存在争议。基于腹腔镜设备、技术的进步以及腹腔镜辅助D2全胃切除术的实践经验，我们对胃中上部IV期或转移性胃癌且伴有局部胃出血、疼痛、梗阻等症状且其他治疗方法无效的患者实施了腹腔镜辅助非根治性全胃切除术。本研究旨在确定腹腔镜辅助非根治性全胃切除术在IV期疾病或转移性胃癌患者中的可行性。
2005年7月至2007年9月期间，我们对43例胃中上部IV期疾病或转移性胃癌且伴有局部胃出血、疼痛、梗阻等症状且其他治疗方法无效的患者实施了腹腔镜辅助非根治性全胃切除术。腹腔镜下分离胃并横断十二指肠第一部。由于相邻组织广泛受累，最终通过剑突下小剖腹切口（5 - 7厘米）在体外进行分离以切除标本并进行吻合。分析该手术的临床资料。
43例患者均未转为开腹手术，未观察到手术死亡病例。18例相邻组织广泛受累的患者通过小剖腹切口在体外进行了最终分离。术后并发症发生4例（9%），1例轻度十二指肠残端漏，3例伤口感染。平均手术时间为245±81分钟，术中失血163±131毫升。术后下床活动时间和首次排气时间分别为2.6±1.3天和3.3±1.0天。所有患者术后均顺利康复。平均住院时间为8.8±3.5天。所有术前症状均缓解。平均生存时间为8.9±3.2个月，5例患者在6 - 15个月的随访期内仍然存活。
腹腔镜辅助非根治性全胃切除术在IV期或转移性胃癌患者中被认为是一种安全可行的方法。对于患有局部胃出血、疼痛、梗阻等症状且其他治疗方法无效的胃癌患者，腹腔镜辅助姑息性全胃切除术可改善其生活质量。
