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腹腔镜-内镜联合手术治疗早期胃癌初期病例技术分析

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目的:回顾性分析既往接受双镜联合手术的早期胃癌患者,评价该手术治疗早期胃癌的可行性.方法:回顾性收集 2013年5月至 2024年 4月于北京大学肿瘤医院接受双镜联合手术的早期胃癌患者.手术方式包括内镜下黏膜切除(endoscopic submu-cosal dissection,ESD)联合腹腔镜淋巴结活检、经典腹腔镜-内镜联合手术(laparoscopic and endoscopic cooperative surgery,LECS)及其改良术式.收集患者临床病理特点、术后恢复指标、并发症及生存结局纳入分析.结果:共纳入 9例患者,中位年龄64岁,男性 6例(66.7%),女性 3例(33.3%).所有患者活检病理均为分化型胃癌.5例(55.6%)患者手术方式为ESD联合腹腔镜淋巴结活检,4例(44.4%)患者行腹腔镜辅助内镜全层切除及前哨淋巴结切检,平均麻醉时间(351.2±91.4)min,平均出血量(34.4±15.1)mL.术后出现 3例(33.3%)并发症,包括 1例胃排空障碍(CD2级),1例腹腔感染(CD2级),1例消化道穿孔(CD3级).中位随访时间 52个月,所有患者无复发及死亡.结论:双镜联合手术治疗早期胃癌具有可行性,其肿瘤学安全性仍需要进一步研究证实.LECS技术、适应证人群选择和前哨淋巴结切检准确率是进一步研究的重点.
Laparoscopy and endoscopy cooperative surgery for early gastric cancer:technical analysis of initial cases
Objective:To retrospectively analyze the efficiency of laparoscopic and endoscopic cooperative surgery(LECS)for early gastric cancer treatment.Methods:We retrospectively collected data from patients with early gastric cancer who underwent LECS at the Peking University Cancer Hospital&Institute between May,2013 and April,2024.Patients underwent endoscopic submucosal dissection(ESD)with laparoscopic lymph node biopsy,classical LECS,and other modified procedures.Additionally,clinical and pathological characteristics,post-operative recovery indicators,complications,and survival outcomes of the patients were analyzed.Results:Nine patients(median age:64 years),including six male(66.7% )and three female(33.3% )patients,were involved in this study.Biopsy revealed that all patients had well-differentiated gastric cancer.Five patients(55.6% )underwent ESD with laparoscopic lymph node biopsy,and four patients(44.4% )under-went laparoscopically assisted endoscopic full-thickness resection and sentinel lymph node biopsy.Average anesthesia time was(351.2±91.4)min,and average blood loss was(34.4±15.1)mL.After surgery,three patients(33.3% )experienced complications,with one case each of gastric stasis(CD2),intra-abdominal infection(CD2),and gastrointestinal perforation(CD3).The median follow-up time was 52 months,and no cases of disease recurrence or death were observed.Conclusions:Overall,this study highlights the efficiency of LECS for early gastric cancer treatment.Future studies should assess its oncological safety,along with other technical aspects,patient selection criter-ia,and accuracy of sentinel lymph node biopsy,to facilitate widespread application of LECS.

laparoscopic and endoscopic cooperative surgery(LECS)early gastric cancersentinel lymph nodefunction-preserving sur-gery

邢继尧、苗儒林、吴齐、王警、陕飞、李子禹

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北京大学肿瘤医院暨北京市肿瘤防治研究所胃肠肿瘤中心,恶性肿瘤发病机制及转化研究教育部重点实验室(北京市 100142)

腹腔镜-内镜联合手术 早期胃癌 前哨淋巴结 功能保留手术

首都卫生发展科研专项项目

2024-1-2152

2024

中国肿瘤临床
中国抗癌协会

中国肿瘤临床

CSTPCD北大核心
影响因子:1.32
ISSN:1000-8179
年,卷(期):2024.51(13)