第21卷第1期 腹腔镜外科杂志 Vol. 21. No. 1 2016年1月 JOURNAL OF LAP AROSCOPIC SURGERY Jan.2016 目前的研究认为,腹腔镜辅助胃癌根治术具有呼吸道病史的患者尤为严重,上腹部切口引起的术 较少的术后切口并发症(切口感染、切口裂开、切口后疼痛限制了膈肌的活动范围,影响患者术后有效 疝等)与肺部相关并发症(肺部感染、肺不张、胸腔咳嗽、咳痰、深呼吸等,从而增加了肺不张、胸腔积 积液等),但在主要手术相关并发症(十二指肠残液、肺部感染等肺部并发症发生率。在这一方面腹 端漏、吻合口漏、胃瘫、急性胰腺炎、腹腔岀血)方面腔镜辅助胃癌根治术具有一定优势。此外,腹腔镜 并无优势。研究结果显示,影响腹腔镜术后辅助胃癌根治术的微创性质较少的术中刺激与干 并发症的主要因素是淋巴结清扫程度及外科医师的扰使得切口感染的并发症发生率有所下降。受样本 手术经验。我们认为,腹腔镜手术的微创性、较轻的量限制,本研究未对不同手术方式的术后并发症进 术后疼痛与焦虑、更加有效的术后活动是腹腔镜辅行对比分析,仍需后续扩大样本量进一步研究。 助胃癌根治术后并发症相对较少的主要原因。全麻 综上所述,腹腔镜辅助胃癌根治术安全、可靠, 气管插管刺激呼吸道内分泌物产生,既往吸烟或有近期疗效肯定,具有切口小、出血少、康复快等优势。 参考文献: [1 Jemal A, Bray F, Center MM, et al. Global cancer statistics[ J]. CA Cancer J Clin, 2011, 61(2): 69-90 [2NccnClinicalPracticeGuidelinesinOncologyofgastriccancerV.I[eb/oL]-[2014].httP://www.ncen.org [3] Park DJ, Lee HJ, Kim HH, et al. Predictors of operative morbidity and mortality in gastric cancer surgery[J]. Br J Surg, 2005, 9 (9):1099-1102 [4 Gotoda T, Kondo H, Ono H, et al. A new endoscopic mucosal resection procedure using an insulation-tipped electrosurgical knife for rectal flat lesions: Report of two cases[ J]. Gastrointest Endosc, 1999, 50(4): 560-563 [5 Huscher CG, Mingoli A, Sgarzini G, et al. Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial[ J]. Ann Surg, 2005, 241(2): 232-237. n interim report: a phase Ill multicenter, prospective, randomized Trial( KLASS Trial)[J]. Ann Surg, 2010, 251(3): 417-420 [6]Kim HH, Hyung WJ, Cho GS, et al. Morbidity and mortality of laparoscopic gastrectomy versu for [7] Uyama I, Suda K, Satoh S. Laparoscopic surgery for advanced gastric cancer: current status and future perspectives[]. JGastric Cancer,2013,13(1):19-25 [8 Zhao Y, Yu P, Hao Y, et al. Comparison of outcomes for laparoscopically assisted and open radical distal gastrectomy with lymph- adenectomy for advanced gastric cancer[J]. Surg Endosc, 2011, 25(9): 2960-2966 [9] Gordon AC, Kojima K, Inokuchi M, et al. Long-term comparison of laparoscopy-assisted distal gastrectomy and open distal gas- trectomy in advanced gastric cancer[J]. Surg Endosc, 2013, 27(7): 462-470 [10] Roviello F, Rossi S, Marrelli D, et al. Number of lymph node metastases and its prognostic nce in early gastric cancer: a multicenter Italian study[J].J Surg Oncol, 2006, 94(4): 275-280 [11] Song KY, Kim SN, Park CH Laparoscopy-assisted distal gastrectomy with D, lymph node dissection for gastric cancer: technica and oncologic aspects[J]. Surg Endosc, 2008, 22(3): 655-659. [ 12] Ohtani H, Tamamori Y, Noguchi K, et al. A meta analysis of randomized controlled trials that compared laparoscopy-assisted and open distal gastrectomy for early gastric cancer[J]. J Gastrointest Surg, 2010, 14(6): 958-964 [13] Kim YW, Yoon HM, Yun YH, et al. Long-term outcomes of laparoscopy-assisted distal gastrectomy for early gastric cancer: result of a randomized controlled trial( COACT 0301)[J]. Surg Endosc, 2013, 27(11): 4267-4276 [14] Takiguchi S, Fujiwara Y, Yamasaki M, et al. Laparoscopy-assisted distal gastrectomy versus open distal gastrectomy: A prospec- tive randomized single-blind study[J]. World J Surg, 2013, 37(10): 2379-2386 [15]Huang YL, Lin HG, Yang JW, et al. Laparoscopy-assisted versus open gastrectomy with D2 lymph node dissection for advanced gastric cancer: a meta-analysis[J]. Int J Clin Exp Med, 2014, 7(6): 1490-1499 [16] Junfeng S,Jun L, Jianwei W, et al. Meta-analysis of randomized controlled trials on laparoscopic gastrectomy vs open gastrectomy for distal gastric cancer[J]. Hepato Gastroenterol, 2012, 59(118): 1699-1705 [17] Ryu KW, Kim YW, Lee JH, et al. Surgical complications and the risk factors of laparoscopy-assisted distal gastrectomy in early gastric cancer[J]. Ann Surg Oncol, 2008, 15(6): 1625-1631 (收稿日期:2015-12-01) (英文编辑:杨庆芸)目前的研究认为,腹腔镜辅助胃癌根治术具有 较少的术后切口并发症(切口感染、切口裂开、切口 疝等)与肺部相关并发症(肺部感染、肺不张、胸腔 积液等) [15] ,但在主要手术相关并发症(十二指肠残 端漏、吻合口漏、胃瘫、急性胰腺炎、腹腔出血)方面 并无优势[16] 。 研究结果显示[17] ,影响腹腔镜术后 并发症的主要因素是淋巴结清扫程度及外科医师的 手术经验。 我们认为,腹腔镜手术的微创性、较轻的 术后疼痛与焦虑、更加有效的术后活动是腹腔镜辅 助胃癌根治术后并发症相对较少的主要原因。 全麻 气管插管刺激呼吸道内分泌物产生,既往吸烟或有 呼吸道病史的患者尤为严重,上腹部切口引起的术 后疼痛限制了膈肌的活动范围,影响患者术后有效 咳嗽、咳痰、深呼吸等,从而增加了肺不张、胸腔积 液、肺部感染等肺部并发症发生率。 在这一方面,腹 腔镜辅助胃癌根治术具有一定优势。 此外,腹腔镜 辅助胃癌根治术的微创性质、较少的术中刺激与干 扰使得切口感染的并发症发生率有所下降。 受样本 量限制,本研究未对不同手术方式的术后并发症进 行对比分析,仍需后续扩大样本量进一步研究。 综上所述,腹腔镜辅助胃癌根治术安全、可靠, 近期疗效肯定,具有切口小、出血少、康复快等优势。 参考文献: [1] Jemal A,Bray F,Center MM,et al. Global cancer statistics[J]. CA Cancer J Clin,2011,61(2):69-90. [2] NCCN Clinical Practice Guidelines in Oncology of gastric cancer V. 1[EB/ OL]. [2014]. http: / / www. nccn. org. [3] Park DJ,Lee HJ,Kim HH,et al. Predictors of operative morbidity and mortality in gastric cancer surgery[J]. Br J Surg,2005,92 (9):1099-1102. [4] Gotoda T,Kondo H,Ono H,et al. A new endoscopic mucosal resection procedure using an insulation-tipped electrosurgical knife for rectal flat lesions:Report of two cases[J]. Gastrointest Endosc,1999,50(4):560-563. [5] Huscher CG,Mingoli A,Sgarzini G,et al. Laparoscopic versus open subtotal gastrectomy for distal gastric cancer:five-year results of a randomized prospective trial[J]. Ann Surg,2005,241(2):232-237. [6] Kim HH,Hyung WJ,Cho GS,et al. Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer-- an interim report:a phase III multicenter,prospective,randomized Trial (KLASS Trial)[J]. Ann Surg,2010,251(3):417-420. [7] Uyama I,Suda K,Satoh S. Laparoscopic surgery for advanced gastric cancer:current status and future perspectives[J]. J Gastric Cancer,2013,13(1):19-25. [8] Zhao Y,Yu P,Hao Y,et al. Comparison of outcomes for laparoscopically assisted and open radical distal gastrectomy with lymph￾adenectomy for advanced gastric cancer[J]. Surg Endosc,2011,25(9):2960-2966. [9] Gordon AC,Kojima K,Inokuchi M,et al. Long-term comparison of laparoscopy-assisted distal gastrectomy and open distal gas￾trectomy in advanced gastric cancer[J]. Surg Endosc,2013,27(7):462-470. [10] Roviello F,Rossi S,Marrelli D,et al. Number of lymph node metastases and its prognostic significance in early gastric cancer:a multicenter Italian study[J]. J Surg Oncol,2006,94(4):275-280. [11] Song KY,Kim SN,Park CH. Laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for gastric cancer:technical and oncologic aspects[J]. Surg Endosc,2008,22(3):655-659. [12] Ohtani H,Tamamori Y,Noguchi K,et al. A meta analysis of randomized controlled trials that compared laparoscopy-assisted and open distal gastrectomy for early gastric cancer[J]. J Gastrointest Surg,2010,14(6):958-964. [13] Kim YW,Yoon HM,Yun YH,et al. Long-term outcomes of laparoscopy-assisted distal gastrectomy for early gastric cancer:result of a randomized controlled trial (COACT 0301)[J]. Surg Endosc,2013,27(11):4267-4276. [14] Takiguchi S,Fujiwara Y,Yamasaki M,et al. Laparoscopy-assisted distal gastrectomy versus open distal gastrectomy:A prospec￾tive randomized single-blind study[J]. World J Surg,2013,37(10):2379-2386. [15] Huang YL,Lin HG,Yang JW,et al. Laparoscopy-assisted versus open gastrectomy with D2 lymph node dissection for advanced gastric cancer:a meta-analysis[J]. Int J Clin Exp Med,2014,7(6):1490-1499. [16] Junfeng S,Jun L,Jianwei W,et al. Meta-analysis of randomized controlled trials on laparoscopic gastrectomy vs open gastrectomy for distal gastric cancer[J]. Hepato Gastroenterol,2012,59(118):1699-1705. [17] Ryu KW,Kim YW,Lee JH,et al. Surgical complications and the risk factors of laparoscopy-assisted distal gastrectomy in early gastric cancer[J]. Ann Surg Oncol,2008,15(6):1625-1631. (收稿日期:2015-12-01) (英文编辑:杨庆芸) 45 第 21 卷第 1 期 2016 年 1 月 腹 腔 镜 外 科 杂 志 JOURNAL OF LAPAROSCOPIC SURGERY Vol. 21,No. 1 Jan. 2016