目的：探讨完全腹腔镜下行全胃切除术的临床价值。方法：回顾性分析2013 年5 月—2014 年9 月收治的66 例行腹腔镜全胃切除术的胃上部癌患者临床资料，16 例行全腔镜下根治性全胃切除术（全腹腔镜组），50 例行腹腔镜辅助下根治性全胃切除术（腹腔镜辅助组），比较两组患者术前资料、术中指标、术后情况。结果：两组患者术前资料具有可比性。与腹腔镜辅助组比较，全腹腔镜组手术时间延长、住院费用增高（均P<0.05），但在手术切口长度、术后疼痛、术后恢复时间、住院时间、术后并发症发生率方面明显优于前者（均P<0.05）；两组在术中出血、两端切缘距离、淋巴结清扫数目等无统计学差异（均P>0.05）。结论：全腹腔镜下行全胃切除术安全可行，可作为胃癌外科治疗的一种术式及未来微创理念发展的方向。
Feasibility, safety and short-term efficacy of totally laparoscopic total gastrectomy for upper stomach cancer
Objective: To investigate the clinical value of totally laparoscopic total gastrectomy in treatment of cancer of the upper stomach. Methods: The clinical data of 66 patients with cancer of the upper stomach undergoing laparoscopic total gastrectomy from May 2013 to September 2014 were retrospectively analyzed. Of the patients, 16 cases underwent totally laparoscopic total gastrectomy (total-laparoscopic group) and 50 cases were subjected to laparoscopically-assisted total gastrectomy (laparoscopic-assisted group). The preoperative data, intraoperative variables, and postoperative conditions between the two groups of patients were compared. Results: The preoperative data between the two groups were comparable. In total-laparoscopic group compared with laparoscopic-assisted group, the operative time was prolonged, and hospitalization cost was increased (both P<0.05), but it was superior in respects of the length of surgical incision, postoperative pain, time for postoperative recovery, length of postoperative hospital stay and incidence of postoperative complications (all P<0.05). There was no significant difference in intraoperative blood loss, distance from proximal and distal margins of resection, and number of lymph nodes dissected between the two groups (all P>0.05). Conclusion: Totally laparoscopic total gastrectomy is safe and feasible, which provides a treatment choice for gastric cancer and a future direction for the development of the concept of minimal invasiveness.