手辅助腹腔镜胃癌D2根治术中淋巴结清扫模式分析  

Analysis of lymph node dissection patterns in D2 radical gastrectomy by hand-assisted laparoscopic technique

作　　者：曹永宽[1] 刘立业[1] 龚加庆[1] 王永华[1] 罗国德[1] 周均[1] 干伟[1] 黄岭[1] 

机构地区：[1]成都军区总医院全军普通外科中心胃肠外科,610083

出　　处：《中华胃肠外科杂志》2013年第10期970-973,共4页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的探讨手辅助腹腔镜胃癌D：根治术中的淋巴结清扫模式。方法回顾性分析成都军区总医院全军普通外科中心胃肠外科2010年12月至2012年9月间，采用自行设计的手术操作系统所实施的111例手辅助腹腔镜胃癌D：根治术患者的临床资料。患者均采用自左向右、伴随肿瘤一并完整切除的淋巴结清扫模式（逆向卷席式淋巴结清扫模式），即手辅助腹腔镜下完成胃近端区域淋巴结清扫后，在预切除线切断胃或食管，将切除组织移出腹腔外，在直视下完成其他区域的淋巴结清扫．完整切除肿瘤组织，最后进行消化道重建。结果全组患者手术切口长度（6．8±0．3）em；术中出血量（238．4＋113．6）ml；手术时间（171．9±23．3）min。手术切缘残端均无癌残留，病理检获淋巴结数（17．2＋5．7）枚／例。术后并发症10例（9．0％），围手术期死亡1例（0．9％）；术后住院时间（10．1±3．7）d。结论逆向卷席式淋巴结清扫模式可以避免开腹与腹腔镜手术模式的多次转换，有利于手辅助腹腔镜胃癌D：根治术操作流程的标准化。Objective To summarize the experience of lymph node dissection patterns in hand- assisted laparoscopie radical gastrectomy. Methods One hundred and eleven patients with gastric carcinoma between December 2010 and September 2012 were operated by hand-assisted laparoscopic system designed by us. Clinical data were analyzed retrospectively. The lymph nodes were dissected from left to right together with total tumor resection （reverse lymph nodes scavenge pattern）, then digestive tract was reconstructed. Results Total gastrectomy, distal gastrectomy and proximal gastrectomy were performed in 57, 46 and 8 eases respectively. Combined cholecystectomy and lateral segment of left liver lobe were needed in 4 and 2 patients respectively, and 1 case underwent combined splenectomy and pancreatic body and tail resection. TNM staging of patients in [, ]], ]]I A, roB, and IV were 16, 8, 35, 14, and 38, respectively. Histological type was poorly differentiated in 78 cases, moderate differentiation in 26 cases and good differentiation in 7 cases. The incision length was （6.8_＋0.3） cm, blood loss was （238.4_＋113.6） ml, operative time was （171.9_＋23.3） min, number of removed lymph node was 17.2-＋5.7, hospital stay was （ 10.1-＋3.7 ） d, postoperative complication rate was 9.0%. One case died during perioperative time. Conclusions Hand-assisted laparoseopie D2 radical gastrectomy （reverse lymph nodes scavenge pattern） can avoid the multiple conversion of open-laparoscopic operation model, and is beneficial to the standardization for surgical procedure.

关 键 词：胃肿瘤 胃癌根治术 D2淋巴结清扫 手辅助腹腔镜 

分 类 号：R735.2[医药卫生—肿瘤]