Kim Hee Sung, Kim Beom Su, Lee In Seob, Lee Sol, Yook Jeoung Hwan, Kim Byung Sik
Department of Gastric Surgery, Asan Medical Center, Ulsan University School of Medicine, Seoul, Korea.
Surg Laparosc Endosc Percutan Tech. 2014 Apr;24(2):177-82. doi: 10.1097/SLE.0b013e31828f6bfb.
Laparoscopic gastrectomy (LAG) is increasingly used as a treatment for gastric cancer. However, it is contraindicated in patients with previous abdominal surgery, because of a higher risk of enteric injury, technical difficulties associated with adhesions, and longer operative times. The aim of this study was to assess the feasibility and clinical outcomes of LAG in patients who had previously undergone gastrectomy for gastric cancer.
Between June 2008 and May 2012, we performed laparoscopic gastrectomies in 17 patients with remnant stomach cancer who had previously undergone open gastrectomy (10 patients) or LAG (7 patients) for early gastric cancer. We performed laparoscopic distal gastrectomies with Roux-en-Y gastrojejunostomy in 10 patients, and laparoscopic total gastrectomies in 7 patients.
None of the patients required conversion to open surgery or intraoperative transfusion. One patient with postoperative bleeding received a transfusion of 4 U of blood. There were 2 cases of serious postoperative complications: 1 internal herniation and 1 anastomosis leakage. One patient experienced tractitis at the trocar site. All patients had tumor-free resection margins, and there were no mortalities.
LAG is a safe and realistic treatment for patients who have previously undergone gastrectomy, although it may be associated with an increased need for adhesiolysis and longer surgery times.
腹腔镜胃切除术（LAG）越来越多地被用于治疗胃癌。然而，对于既往有腹部手术史的患者，该手术是禁忌的，因为肠损伤风险较高、与粘连相关的技术困难以及手术时间较长。本研究的目的是评估LAG在既往因胃癌接受过胃切除术的患者中的可行性和临床结果。
2008年6月至2012年5月期间，我们对17例残胃癌患者进行了腹腔镜胃切除术，这些患者既往因早期胃癌接受过开腹胃切除术（10例）或LAG（7例）。我们对10例患者进行了腹腔镜远端胃切除术并 Roux-en-Y 胃空肠吻合术，对7例患者进行了腹腔镜全胃切除术。
所有患者均无需转为开腹手术或术中输血。1例术后出血患者接受了4单位的输血。有2例严重术后并发症：1例内疝和1例吻合口漏。1例患者在套管针部位发生了穿刺道炎。所有患者的切缘均无肿瘤残留，且无死亡病例。
LAG对于既往接受过胃切除术的患者是一种安全且可行的治疗方法，尽管它可能会增加粘连松解的需求和手术时间。
