腹腔镜辅助胃癌D_2根治术淋巴结清扫的早期体会  

The early experience of lymphadenectomy in laparoscopy-assisted D_2 radical resection for gastric cancer

作　　者：陈映波[1] 陈实[1] 冯兴宇[1] 李元方[1] 陈永明[1] 徐大志[1] 周志伟[1] 

机构地区：[1]中山大学肿瘤防治中心胃胰科华南肿瘤学国家重点实验室,广州510060

出　　处：《消化肿瘤杂志（电子版）》2011年第3期167-170,共4页Journal of Digestive Oncology(Electronic Version)

摘　　要：目的分析腹腔镜辅助胃癌D2根治术清扫血管根部各组淋巴结所需时间,探讨各组淋巴结清扫的难点和手术技巧。方法采用观看手术录像方法,计算2010年10月至2011年7月于中山大学肿瘤防治中心施行的25例腹腔镜辅助胃癌D2根治术,分别计算清扫胃网膜左、胃网膜右、胃右及胃左血管根部淋巴结群所需时间,并比较各组淋巴结清扫所需时间在初期15例和后期10例的时间变化。结果 25例患者均顺利完成腹腔镜辅助胃癌D2根治术,无中转开腹及术中、术后严重手术并发症发生。全组25例患者清扫淋巴结总数702枚,平均数为(29.92±8.78)枚。手术所需时间91～212min,平均(129.96±27.91)min,其中清扫网膜左、网膜右、胃右及胃左血管根部淋巴结组群清扫所需时间分别为(23.64±4.15)min、(25.60±6.38)min、(24.52±7.23)min及(18.40±3.75)min。初期15例清扫网膜左、网膜右、胃右及胃左血管根部淋巴结组群清扫所需时间分别为(23.13±3.02)min、(28.07±5.16)min、(27.80±6.13)min及(17.00±2.39)min,后期10例所需时间分别为(24.40±5.54)min、(21.90±6.47)min、(19.60±6.02)min及(20.50±4.53)min,对比前后两组变化,原来最为耗时的网膜右、胃右血管根部淋巴结清扫时间显著缩短,差异有统计学意义(P<0.05)。结论腹腔镜辅助胃癌D2根治术安全可行。4根主要胃周血管根部淋巴结组群清扫耗时从长至短依次为胃网膜右、胃右、胃网膜左及胃左血管,而经过相当病例的实践后,耗时按从长至短顺序依次为胃网膜左、胃网膜右、胃左及胃右血管周围淋巴结组群。Objective To compare the time required for lymphadenectomy of lymph node groups around the 4 main peri-gastric vessles,and investigate the surgical techniques and difficulties of lymph node dissection in laparoscopy-assisted radical resection for gastric cancer. Methods Twenty-five gastric cancer patients underwent laparoscopy-assisted D2 radical resection in our hospital from October 2010 to July 2011.The times required for lymphadenectomy of lymph node groups around the 4 main peri-gastric vessles were calculated through viewing the videos,and then compared between early 15 cases and later 10 cases.Results Laparoscopy-assisted radical resection with D2 lymphadenectomy for gastric cancer was successfully performed in all 25 patients without conversion to open surgery and perioperative complications.For all patients,the mean number of retrieved lymph nodes was(29.92 ± 8.78) and mean time required for lymphadenectomy was(129.96 ± 27.91) min ranging from 91 to 212 min.The times required for lymphadenectomy of lymph node groups around the 4 main peri-gastric vessles,left gastroepiploic,right gastroepiploic,right gastric and left gastric vessles were(23.64±4.15) min,(25.60±6.38) min,(24.52±7.23) min and(18.40±3.75) min,respectively for all patients,and(23.13±3.02) min,(28.07±5.16) min,(27.80±6.13) min,(17.00±2.39)min in the first 15 cases,and(24.40±5.54) min,(21.90±6.47) min,(19.60±6.02) min and(20.50±4.53)min in the later 10 cases.The times required for lymphadenectomy of lymph node groups around right gastroepiploic and right gastric vessles decreased significantly in the later 10 cases than those in the first 15 cases(P<0.05). Conclusions Laparoscopy-assisted radical resection with D2 lymphadenectomy for gastric cancer is safe and feasible.The time-consuming sequences of lymphadenectomy of lymph node groups around the 4 main peri-gastric vessles are right gastroepiploic,right gastric,left gastroepiploi and left gastric vessles.After a learning curve,the time-consuming sequences may change to left gas

关 键 词：胃癌 腹腔镜 D2淋巴结清扫 

分 类 号：R735.2[医药卫生—肿瘤]