腹腔镜下保留迷走神经及幽门胃切除术治疗早期胃癌的临床疗效

Clinical efficacy of laparoscopic vagus nerve and pylorus preserving gastrectomy for early gastric cancer

    摘要
  • 摘要: 目的:探讨腹腔镜下保留迷走神经及幽门的胃切除术治疗早期胃癌的临床疗效。
    方法:采用回顾性描述性研究方法。收集2016年5—9月北京大学肿瘤医院收治的5例行腹腔镜下保留迷走神经及幽门的胃切除术治疗早期胃癌患者的临床资料。患者行腹腔镜辅助或全腹腔镜保留迷走神经(肝支、腹腔支)及幽门的胃切除术。观察指标：(1)手术情况。(2)术后情况。(3)术后病理学检查情况。(4)随访情况。采用门诊和电话方式进行随访，了解患者术后生存、肿瘤转移和复发情况。随访时间截至2016年12月。正态分布的计量资料以平均值(范围)表示。
    结果:(1)手术情况：5例患者均顺利完成腹腔镜下保留迷走神经及幽门的胃切除术，其中3例消化道重建通过辅助切口完成，2例为全腹腔镜手术；3例采用器械侧侧吻合，2例采用手工端端吻合。5例患者均保留迷走神经肝支和腹腔支，平均手术时间为220 min (180～305 min)，平均术中出血量为108 mL(30～216 mL)。(2)术后情况：5例患者平均术后肠道首次排气时间为3 d(2～4 d)，平均术后首次进流质食物时间为3 d(1～5 d)，平均术后首次进半流质食物时间为10 d(5～25 d)。1例患者术后发生胃排空延迟，经保守治疗后缓解。5例患者平均术后住院时间为13 d(7～ 32 d)。(3)术后病理学检查情况：5例患者平均淋巴结清扫数目为22 枚(15～35 枚)，平均近端切缘为 3.5 cm(2.2～5.0 cm)，平均远端切缘为3.7 cm(2.0～5.5 cm)。病理学T分期：pT0期1例，pT1a期1例，pT1b期2例，pT2期1例；病理学N分期：pN0期3例，pN2期2例；病理学TNM分期：0期1例，Ⅰa期2例，Ⅱa期1例，Ⅱb期1例。2例患者出现分期迁移，分别为cT1N0期至pT2N2期、cT0N0期至pT1bN2期。(4)随访情况：5例患者均获得术后随访，随访时间为2.8～7.0个月，中位随访时间为5.6个月。随访期间，无患者肿瘤转移、复发和死亡。
    结论:腹腔镜下保留迷走神经及幽门胃切除术治疗早期胃癌安全可行。

     

    Abstract: Objective:To investigate the clinical efficacy of laparoscopic vagus nerve and pyloruspreserving gastrectomy (LVNPPG) for early gastric cancer.
    Methods:The retrospective descriptive study was conducted. The clinical data of 5 patients who underwent LVNPPG for early gastric cancer at the Peking University Cancer Hospital between May 2016 and September 2016 were collected. Patients underwent laparoscopeassisted or total laparoscopic vagus nerve (hepatic branch and celiac branch) and pyloruspreserving gastrectomy. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) postoperative pathological examination; (4) followup situations. Followup using outpatient examination and telephone interview was performed to detect survival of patients and tumor metastasis and recurrence up to December 2016. Measurement data with normal distribution was represented as average (range).
    Results:(1) Surgical situations: of 5 patients undergoing successful LVNPPG, digestive tract reconstruction using auxiliary incision was conducted in 3 patients and total laparoscopic surgery in 2 patients. Three patients received appliance sidetoside anastomosis and 2 received manual endtoend anastomosis. Hepatic branch and celiac branch of vagus nerve in 5 patients were preserved. Average operation time and volume of intraoperative blood loss were 220 minutes (range, 180-305 minutes) and 108 mL (range, 30-216 mL). (2) Postoperative situations: average time to initial bowel exsufflation, average times for fluid diet intake and for semifluid diet intake were 3 days (range, 2-4 days), 3 days (range, 1-5 days) and 10 days (range, 5- 25 days), respectively. One patient complicated with delayed gastric emptying was improved by conservative treatment. Duration of hospital stay of 5 patients was 13 days (range, 7-32 days). (3) Postoperative pathological examination: number of lymph node dissected, average lengths of proximal margin and distal margin were 22 (range, 15-35), 3.5 cm (range, 2.2-5.0 cm) and 3.7 cm (range, 2.0-5.5 cm), respectively. Pathological T stage: pT0 stage was detected in 1 patient, pT1a stage in 1 patient, pT1b stage in 2 patients and pT2 stage in 1 patient. Pathological N stage: pN0 stage was detected in 3 patients and pN2 in 2 patients. Pathological TNM stage: 0 stage was detected in 1 patient, Ⅰa stage in 2 patients, Ⅱa stage in 1 patient and Ⅱb stage in 1 patient. Two patients had stage migration, including from cT1N0 to pT2N2 and from cT0N0 to pT1bN2. (4) Followup situations: 5 patients were followed up for 2.8-7.0 months, with a median time of 5.6 months. During followup, there were no death and occurrence of tumor metastasis and recurrence.
    Conclusion:LVNPPG is safe and feasible for early gastric cancer.

     

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