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1、中国微创外科杂志2011年9月第11卷第9期ChinJMinInvSurg,September2011,Vo.l11.No.9779临床论著早期开展腹腔镜胃癌手术的并发症分析冯立民李刚张华杰孙宪春林骏杨世春(青岛大学附属烟台毓璜顶医院肿瘤外科,烟台264000)摘要目的探讨早期开展腹腔镜胃癌手术出现的并发症及预防、治疗措施。方法回顾性分析2009年6月~2010年6月50例腹腔镜胃癌D2手术的临床资料,包括手术方式、中转开腹率、手术时间、术中出血量、手术并发症等。腹腔镜下行D2淋巴清扫,上腹小切口切除标本并消化道重建。结果完成腹腔镜手术42例
2、,无围手术期死亡,中转开腹率16%(8/50)。术中并发症发生率8%(4/50),其中重要血管损伤引起出血3例,横结肠系膜损伤1例;术后早期并发症发生率14%(7/50),其中腹腔内出血1例,十二指肠残端漏1例,残胃排空障碍3例,术后切口感染1例,支气管肺炎1例。结论掌握腔镜下特有的解剖层面,提高手术技巧,建立规范的操作步骤,加强团队配合,是防治腹腔镜胃癌手术并发症的关键。关键词腹腔镜;胃肿瘤;并发症;学习曲线中图分类号:R735.206文献标识:A文章编号:1009-6604(2011)09-0779-03ComplicationsofLaparosc
3、opic-assistedGastrectomyinEarlyStageFengLimin,LiGang,ZhangHuajie,etal.DepartmentofOncologicalSurgery,YantaiYuhuangdingHospital,QingdaoUniversity,Yantai264000,ChinaAbstractObjectiveToinvestigatethecomplicationsoflaparoscopic-assistedgastrectomythatwasperformedinearlystage,aswellasthepreventio
4、nandtreatmentofthecomplications.MethodsFromJune2009toJune2010,weperformedlaparoscopic-assistedgastrectomy(D2)on50casesofgastriccancer.D2lymphadenectomywascarriedoutunderalaparoscope,andthenthetumorwasremovedthoughanupperabdominalsmallincision.Thedigestivetractwasreconstructedafterwards.Theclini
5、caldataofthepatients,includingthemodeofoperation,rateofconversiontoopensurgery,operationtime,bloodlossandsurgicalcomplications,wereretrospectivelyreviewed.ResultsLaparoscopic-assistedgastrectomywascompletedsuccessfullyin42caseswithoutperioperativedeath.Theconvertionratetoopensurgerywas16%(8case
6、s).Intraoperativecomplicationsoccurredin8%(4cases)ofthepatients,includinghemorrhagecausedbyinjurytomainvesselsin3cases,andmesocolondamagein1case.Earlypostoperativecomplicationswasdetectedin14%(7cases)ofthecases,includingduodenalstumpfistulain1case,intraperitonealhemorrhagein1cases,delayedgastrice
7、mptyingin3cases,pneumoniain1case,andincisionalinfectionin1case.ConclusionsItiscrucialtofullyunderstandthelaparoscopicanatomyofthefasciaaroudthestomach,improveoperatingskills,establishastandardoperationalprocess,andre
