腹腔鏡胃癌手術并發癥的預防和處理_《中國普外基礎與臨床雜志》

作者：

張健 , 胡祥

大連醫科大學附屬第一醫院普外一科(遼寧大連116011);

關鍵詞：

胃癌腹腔鏡手術并發癥預防處理

視頻：

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目的總結腹腔鏡胃癌手術并發癥的現狀，探討腹腔鏡下胃癌手術的陷阱和手術并發癥的預防及處理辦法。方法復習國內、外相關文獻，并結合自己的臨床經驗進行分析。結果腹腔鏡胃癌手術并發癥主要有手術本身和人工氣腹相關并發癥。腹腔鏡下視野的局限，立體空間和手指觸覺的喪失，新器械、新技術的使用以及工作環境的改變，增加了手術難度和發生并發癥的可能。清楚的鏡下手術解剖層次，正確的淋巴結清掃方法和消化道重建，是減少腹腔鏡胃癌手術并發癥發生的基礎。結論掌握正確的手術操作原則可以減少腹腔鏡胃癌手術并發癥的發生。

引用本文： 張健,胡祥. 腹腔鏡胃癌手術并發癥的預防和處理. 中國普外基礎與臨床雜志, 2011, 18(2): 122-125. doi: 復制

1.	Kitano S, Iso Y, Moriyama M, et al. Laparoscopyassisted Billroth Ⅰ gastrectomy [J]. Surg Laparosc Endosc, 1994, 4(2): 146148.
2.	Naka T, Ishikura T, Shibata S, et al. Laparoscopyassisted and open distal gastrectomies for early gastric cancer at a general hospital in Japan [J]. Hepatogastroenterology, 2005, 52(61): 293297.
3.	Dulucq JL, Wintringer P, Stabilini C, et al. Laparoscopic and open gastric resections for malignant lesions: a prospective comparative study [J]. Surg Endosc, 2005, 19(7): 933938.
4.	Lee JH, Yom CK, Han HS. Comparison of longterm outcomes of laparoscopyassisted and open distal gastrectomy for early gastric cancer [J]. Surg Endosc, 2009, 23(8): 17591763.
5.	Hwang SI, Kim HO, Yoo CH, et al. Laparoscopicassisted distal gastrectomy versus open distal gastrectomy for advanced gastric cancer [J]. Surg Endosc, 2009, 23(6): 12521258.
6.	Japan Society for Endoscopic Surgery. Nationwide survey on endoscopic surgery in Japan [J]. J Jpn Soc Endosc Surg, 2004, 9(7): 495500.
7.	Japan Society for Endoscopic Surgery. Nationwide survey on endoscopic surgery in Japan [J]. J Jpn Soc Endosc Surg, 2008, 5(5): 525529.
8.	鄭民華, 臧潞. 腹腔鏡外科治療早期胃癌的現狀 [J]. 內科理論與實踐, 2010, 5(3): 203206.
9.	Goh PM, Khan AZ, So JB, et al. Early experience with laparoscopic radical gastrectomy for advanced gastric cancer [J]. Surg Laparosc Endosc Percutan Tech, 2001, 11(2): 8387.
10.	Sarela AI. Entirely laparoscopic radical gastrectomy for adenocarcinoma: lymph node yield and resection margins [J]. Surg Endosc, 2009, 23(1): 153160.
11.	Japanese Gastric Cancer Association. Guidelines for the treatment of gastric cancer [M]. 2nd. Eds. Tokyo: Kanehara, 2004: 4042.
12.	Japanese Gastric Cancer Association. Guidelines for the treatment of gastric cancer [M]. 3rd. Eds. Tokyo: Kanehara, 2010: 3031.
13.	胡祥. 日本《胃癌治療指南》(第3版)解讀 [J]. 中國實用外科雜志, 2010, 30(1): 2530.
14.	余佩武. 胃癌腹腔鏡手術現狀 [J]. 臨床外科雜志, 2008, 16(10): 654656.
15.	Ly QP, Sasson AR. Modern surgical considerations for gastric cancer [J]. J Natl Compr Netw, 2008, 6(9): 885894.
16.	Memon MA, Khan S, Yunus RM, et al. Metaanalysis of laparoscopic and open distal gastr ectomy for gastric carcinoma [J]. Surg Endosc, 2008, 22(8): 17811789.
17.	Park JM, Jin SH, Lee SR, et al. Complications with laparoscopically assisted gastrectomy: multivariate analysis of 300 consecutive cases [J]. Surg Endosc, 2008, 22(10): 21332139.
18.	余佩武. 腹腔鏡胃癌根治術的原則與評價 [J]. 中國普外基礎與臨床雜志, 2009, 16(1): 15.
19.	Lee JH, Han HS, Lee JH. A prospective randomized study comparing open vs laparoscopyassisted distal gastrectomy in early gastric cancer: early results [J]. Surg Endosc, 2005, 19(2): 168173.
20.	Weber KJ, Reyes CD, Gagner M, et al. Comparison of laparoscopic and open gastrectomy for malignant disease [J]. Surg Endosc, 2003, 17(6): 968971.
21.	Lee SI, Choi YS, Park DJ, et al. Comparative study of laparoscopyassisted distal gastrectomy and open distal gastrectomy [J]. J Am Coll Surg, 2006, 202(6): 874880.
22.	Tanimura S, Higashino M, Fukunaga Y, et al. Laparoscopic gastrectomy for gastric cancer: experience with more than 600 cases [J]. Surg Endosc, 2008, 22(5): 11611164.
23.	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.
24.	Hosono S, Arimoto Y, Ohtani H, et al. Metaanalysis of shortterm outcomes after laparoscopicassisted distal gastrectomy [J]. World J Gastroenterol, 2006, 12(47): 76767683.
25.	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.
26.	余佩武, 錢鋒, 羅華星, 等. 腹腔鏡胃癌根治術的臨床療效 [J]. 中華消化外科雜志, 2008, 7(1): 3840.
27.	Kitano S, Shiraishi N, Uyama I, et al. A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan [J]. Ann Surg, 2007, 245(1): 6872.
28.	臧潞, 胡偉國, 李佑, 等. 腹腔鏡早期胃癌根治術后臨床研究 [J]. 內科理論與實踐, 2010, 5(3): 210213.
29.	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.
30.	錢峻, 湯黎明, 朱杰, 等. 腹腔鏡胃癌根治手術中的團隊配合 [J]. 中國微創外科雜志, 2009, 9(9): 781783.
31.	吳濤, 李國新, 丁自海, 等. 腹腔鏡下遠端胃癌根治術中胃背系膜及系膜間隙的解剖形態特點 [J]. 中國臨床解剖學雜志, 2007, 25(3): 251254.
32.	Ogura G, Nakamura R, Muragaki Y, et al. Development of an articulating ultrasonically activated device for laparoscopic surgery [J]. Surg Endosc, 2009, 23(9): 21382142.
33.	Oz BS, Mataraci I, Iyem H, et al. Comparison of ultrasonically activated scalpel and traditional technique in radical artery harvesting: clinical research [J]. Thorac Cardiovasc Surg, 2007, 55(2): 104107.
34.	鄭勇斌, 童仕倫, 譚海燕, 等. 超聲刀在腹腔鏡胃癌根治手術中的應用 [J]. 中國普外基礎與臨床雜志, 2009, 16(10): 781784.
35.	Tokunaga M, Hiki N, Fukunaga T, et al. Quality control and educational value of laparoscopyassisted gastrectomy in a highvolume center [J]. Surg Endosc, 2009, 23(2): 289291.
36.	Pugliese R, Maggioni D, Sansonna F, et al. Total and subtotal laparoscopic gastrectomy for adenocarcinoma [J]. Surg Endosc, 2007, 21(1): 2127.
37.	Lee JH, Kim YW, Ryu KW, et al. A phaseⅡ clinical trial of laparoscopyassisted distal gastrectomy with D2 lymph node dissection for gastric cancer patients [J]. Ann Surg Oncol, 2007, 14(11): 31483153.
38.	Hao YX, Yu PW, Zhong H, et al. Comparison of laparoscopic and open gastrectomy on cancer cells exfoliating from the cancerinvaded serosa [J]. Surg Laparosc Endosc Percutan Tech, 2009, 19(3): 201207.
39.	陳凜. 腹腔鏡胃癌根治術后并發癥的預防及處理　 [J/OL]. 中華普外科手術學雜志(電子版), 2008, 2(1): 2627.
40.	李佑, 王明亮. 早期胃癌的腹腔鏡手術治療進展　 [J/OL]. 中華腔鏡外科雜志(電子版), 2008, 1(2): 119122.
41.	Varela JE, Hiyashi M, Nguyen T, et al. Comparison of laparoscopic and open gastrectomy for gastric cancer [J]. Am J Surg, 2006, 192(6): 837842.
42.	松井英男. 食道空腸順蠕動側側吻合口法(胃全摘後 RouxenY食道空腸側側吻合) [J]. 手術, 2010, 64(10): 14551460.

1. Kitano S, Iso Y, Moriyama M, et al. Laparoscopyassisted Billroth Ⅰ gastrectomy [J]. Surg Laparosc Endosc, 1994, 4(2): 146148.
2. Naka T, Ishikura T, Shibata S, et al. Laparoscopyassisted and open distal gastrectomies for early gastric cancer at a general hospital in Japan [J]. Hepatogastroenterology, 2005, 52(61): 293297.
3. Dulucq JL, Wintringer P, Stabilini C, et al. Laparoscopic and open gastric resections for malignant lesions: a prospective comparative study [J]. Surg Endosc, 2005, 19(7): 933938.
4. Lee JH, Yom CK, Han HS. Comparison of longterm outcomes of laparoscopyassisted and open distal gastrectomy for early gastric cancer [J]. Surg Endosc, 2009, 23(8): 17591763.
5. Hwang SI, Kim HO, Yoo CH, et al. Laparoscopicassisted distal gastrectomy versus open distal gastrectomy for advanced gastric cancer [J]. Surg Endosc, 2009, 23(6): 12521258.
6. Japan Society for Endoscopic Surgery. Nationwide survey on endoscopic surgery in Japan [J]. J Jpn Soc Endosc Surg, 2004, 9(7): 495500.
7. Japan Society for Endoscopic Surgery. Nationwide survey on endoscopic surgery in Japan [J]. J Jpn Soc Endosc Surg, 2008, 5(5): 525529.
8. 鄭民華, 臧潞. 腹腔鏡外科治療早期胃癌的現狀 [J]. 內科理論與實踐, 2010, 5(3): 203206.
9. Goh PM, Khan AZ, So JB, et al. Early experience with laparoscopic radical gastrectomy for advanced gastric cancer [J]. Surg Laparosc Endosc Percutan Tech, 2001, 11(2): 8387.
10. Sarela AI. Entirely laparoscopic radical gastrectomy for adenocarcinoma: lymph node yield and resection margins [J]. Surg Endosc, 2009, 23(1): 153160.
11. Japanese Gastric Cancer Association. Guidelines for the treatment of gastric cancer [M]. 2nd. Eds. Tokyo: Kanehara, 2004: 4042.
12. Japanese Gastric Cancer Association. Guidelines for the treatment of gastric cancer [M]. 3rd. Eds. Tokyo: Kanehara, 2010: 3031.
13. 胡祥. 日本《胃癌治療指南》(第3版)解讀 [J]. 中國實用外科雜志, 2010, 30(1): 2530.
14. 余佩武. 胃癌腹腔鏡手術現狀 [J]. 臨床外科雜志, 2008, 16(10): 654656.
15. Ly QP, Sasson AR. Modern surgical considerations for gastric cancer [J]. J Natl Compr Netw, 2008, 6(9): 885894.
16. Memon MA, Khan S, Yunus RM, et al. Metaanalysis of laparoscopic and open distal gastr ectomy for gastric carcinoma [J]. Surg Endosc, 2008, 22(8): 17811789.
17. Park JM, Jin SH, Lee SR, et al. Complications with laparoscopically assisted gastrectomy: multivariate analysis of 300 consecutive cases [J]. Surg Endosc, 2008, 22(10): 21332139.
18. 余佩武. 腹腔鏡胃癌根治術的原則與評價 [J]. 中國普外基礎與臨床雜志, 2009, 16(1): 15.
19. Lee JH, Han HS, Lee JH. A prospective randomized study comparing open vs laparoscopyassisted distal gastrectomy in early gastric cancer: early results [J]. Surg Endosc, 2005, 19(2): 168173.
20. Weber KJ, Reyes CD, Gagner M, et al. Comparison of laparoscopic and open gastrectomy for malignant disease [J]. Surg Endosc, 2003, 17(6): 968971.
21. Lee SI, Choi YS, Park DJ, et al. Comparative study of laparoscopyassisted distal gastrectomy and open distal gastrectomy [J]. J Am Coll Surg, 2006, 202(6): 874880.
22. Tanimura S, Higashino M, Fukunaga Y, et al. Laparoscopic gastrectomy for gastric cancer: experience with more than 600 cases [J]. Surg Endosc, 2008, 22(5): 11611164.
23. 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.
24. Hosono S, Arimoto Y, Ohtani H, et al. Metaanalysis of shortterm outcomes after laparoscopicassisted distal gastrectomy [J]. World J Gastroenterol, 2006, 12(47): 76767683.
25. 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.
26. 余佩武, 錢鋒, 羅華星, 等. 腹腔鏡胃癌根治術的臨床療效 [J]. 中華消化外科雜志, 2008, 7(1): 3840.
27. Kitano S, Shiraishi N, Uyama I, et al. A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan [J]. Ann Surg, 2007, 245(1): 6872.
28. 臧潞, 胡偉國, 李佑, 等. 腹腔鏡早期胃癌根治術后臨床研究 [J]. 內科理論與實踐, 2010, 5(3): 210213.
29. 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.
30. 錢峻, 湯黎明, 朱杰, 等. 腹腔鏡胃癌根治手術中的團隊配合 [J]. 中國微創外科雜志, 2009, 9(9): 781783.
31. 吳濤, 李國新, 丁自海, 等. 腹腔鏡下遠端胃癌根治術中胃背系膜及系膜間隙的解剖形態特點 [J]. 中國臨床解剖學雜志, 2007, 25(3): 251254.
32. Ogura G, Nakamura R, Muragaki Y, et al. Development of an articulating ultrasonically activated device for laparoscopic surgery [J]. Surg Endosc, 2009, 23(9): 21382142.
33. Oz BS, Mataraci I, Iyem H, et al. Comparison of ultrasonically activated scalpel and traditional technique in radical artery harvesting: clinical research [J]. Thorac Cardiovasc Surg, 2007, 55(2): 104107.
34. 鄭勇斌, 童仕倫, 譚海燕, 等. 超聲刀在腹腔鏡胃癌根治手術中的應用 [J]. 中國普外基礎與臨床雜志, 2009, 16(10): 781784.
35. Tokunaga M, Hiki N, Fukunaga T, et al. Quality control and educational value of laparoscopyassisted gastrectomy in a highvolume center [J]. Surg Endosc, 2009, 23(2): 289291.
36. Pugliese R, Maggioni D, Sansonna F, et al. Total and subtotal laparoscopic gastrectomy for adenocarcinoma [J]. Surg Endosc, 2007, 21(1): 2127.
37. Lee JH, Kim YW, Ryu KW, et al. A phaseⅡ clinical trial of laparoscopyassisted distal gastrectomy with D2 lymph node dissection for gastric cancer patients [J]. Ann Surg Oncol, 2007, 14(11): 31483153.
38. Hao YX, Yu PW, Zhong H, et al. Comparison of laparoscopic and open gastrectomy on cancer cells exfoliating from the cancerinvaded serosa [J]. Surg Laparosc Endosc Percutan Tech, 2009, 19(3): 201207.
39. 陳凜. 腹腔鏡胃癌根治術后并發癥的預防及處理　 [J/OL]. 中華普外科手術學雜志(電子版), 2008, 2(1): 2627.
40. 李佑, 王明亮. 早期胃癌的腹腔鏡手術治療進展　 [J/OL]. 中華腔鏡外科雜志(電子版), 2008, 1(2): 119122.
41. Varela JE, Hiyashi M, Nguyen T, et al. Comparison of laparoscopic and open gastrectomy for gastric cancer [J]. Am J Surg, 2006, 192(6): 837842.
42. 松井英男. 食道空腸順蠕動側側吻合口法(胃全摘後 RouxenY食道空腸側側吻合) [J]. 手術, 2010, 64(10): 14551460.

《中國普外基礎與臨床雜志》

腹腔鏡胃癌手術并發癥的預防和處理

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

《中國普外基礎與臨床雜志》

腹腔鏡胃癌手術并發癥的預防和處理

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料