保留脾脏的近端胃癌D2根治术脾门淋巴结清扫  

Clinical Study of the Splenic Hilar Lymph Node Dissection of Splenectomy versus Splenic Preservation in Patients with Proximal Gastric Cancer

作　　者：袁建保 段文斌[2] 段伦喜[2] 

机构地区：[1]湖南省石门县人民医院普通外科,石门415300 [2]中南大学湘雅二医院普通外科,长沙410011

出　　处：《中国现代手术学杂志》2011年第3期191-194,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨保留脾脏的近端胃癌D2根治术行脾门淋巴结清扫的可行性与必要性。方法回顾性分析28例近端胃癌D2根治采用保脾脾门淋巴结清扫的临床资料,并与同期行脾脏切除组21例病人资料相对比。结果保脾组28例手术均顺利完成,无术中中转切脾病例。保脾组与切脾组术中出血量分别为(71.6±30.3)m l和(72.9±31.6)m l,脾门淋巴结阳性率分别为17.9%(5/28)和19.0%(4/21),两组比较差异无统计学意义(P>0.05),而手术时间分别为(3.6±0.4)h和(4.8±0.8)h,住院时间分别为(10.9±1.8)d和(14.0±3.1)d,差异有统计学意义(P<0.05)。保脾组术后无一例脾坏死、脾扭转或静脉血栓形成。结论近端胃癌脾门淋巴结有较高的转移率,保脾清扫既减少了术后并发症的发生,又保留了脾脏对肿瘤的免疫作用。保脾脾门淋巴结清扫实属必要亦切实可行。Objective To study the feasibility and necessity of the splenic hilar lymph node dissection of the spleen preservation in the proximal stomach cancer.Methods A retrospective analysis was carried out in 28 cases underwent spleen preserving D2 gastric radical surgery and 21 patients underwent splenectomy D2 gastric radical surgery.Results The patients of the spleen preserving group were performed successfully without intraoperative splenectomy.The peri-operative bleeding and the positive rate of the splenic hilar lymph nodes had no statistically significant differences,whereas in the spleen preserving group,the operation time and the length of hospital stay were shorter than those of the splenectomy group（P〈0.05）.There was no case suffered spleen necrosis,spleen reverse or venous thrombosis in the spleen preserving group.Conclusions It shows higher splenic hilar lymph node metastasis rate in the proximal stomach cancer.And it is feasible and necessary of the splenic hilar lymph node dissection of the spleen preserving D2 gastric radical surgery for the proximal stomach cancer,with the advantages of low postoperative complications and high immunization on account of the spleen preservation.

关 键 词：胃肿瘤 淋巴结切除术 

分 类 号：R735.2[医药卫生—肿瘤]