Jee Ye Seob
Department of Surgery, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea.
J Korean Surg Soc. 2012 Sep;83(3):130-4. doi: 10.4174/jkss.2012.83.3.130. Epub 2012 Aug 27.
Recently, the number of laparoscopic gastric surgeries increased in Korea. But since many patients prefer to attend larger hospitals, most operations have been performed in high volume center by experienced surgeons, and also most reported studies on laparoscopic gastric surgery have been performed in these hospitals. For better health service and increased access of local residents, district hospitals that have a smaller number of surgical cases also need to perform this surgery safely.
We retrospectively analyzed 58 patients who underwent laparoscopic assisted distal gastrectomy (LADG) from April 2009 to January 2012 in Dankook University Hospital. We compared our data with the retrospective data of the Korean Laparoendoscopic Gastrointestinal Surgery Study (KLASS) group because we thought the KLASS study was a representative study of LADG.
A total of 58 patients underwent LADG during a period of 32 months. The male to female ratio, mean age and body mass index were 34:19, 62.4 years and 23.0 kg/m(2), respectively. More than D1 + β lymph node was dissected in all patients and the mean number of harvested lymph nodes was 31.4. Mean operation time, estimated blood loss and mean hospital stays were 235 minutes, 176 mL and 7.4 days respectively. During the operation, there were no complication and no conversions to open surgery. After the operation, there were 2 cases of wound complication and 1 case of intra-abdominal abscess which improved with conservative treatment and there was no mortality. These data were not different to the data of high volume centers, especially KLASS.
We report first experience with LADG and concluded that LADG could be performed safely in smaller scale hospitals.
近年来，韩国腹腔镜胃手术的数量有所增加。但由于许多患者更倾向于前往大型医院就诊，大多数手术均由经验丰富的外科医生在高容量中心进行，并且大多数已发表的关于腹腔镜胃手术的研究也都是在这些医院开展的。为了提供更好的医疗服务并增加当地居民的就医机会，手术病例数较少的地区医院也需要安全地开展此类手术。
我们回顾性分析了2009年4月至2012年1月在檀国大学医院接受腹腔镜辅助远端胃切除术（LADG）的58例患者。我们将我们的数据与韩国腹腔镜胃肠手术研究（KLASS）组的回顾性数据进行了比较，因为我们认为KLASS研究是LADG的一项代表性研究。
在32个月的时间里，共有58例患者接受了LADG。男女比例、平均年龄和体重指数分别为34:19、62.4岁和23.0kg/m²。所有患者均进行了超过D1+β淋巴结清扫，平均收获淋巴结数为31.4个。平均手术时间、估计失血量和平均住院天数分别为235分钟、176mL和7.4天。手术期间，无并发症发生，也无中转开腹手术的情况。术后，有2例伤口并发症和1例腹腔内脓肿，经保守治疗后好转，无死亡病例。这些数据与高容量中心的数据，尤其是KLASS的数据并无差异。
我们报告了LADG 的首次经验，并得出结论，LADG可以在规模较小的医院安全进行。
