逆向卷席式淋巴结清扫术在手助腹腔镜胃癌根治术中的应用  

Reverse rolling-mat type lymph node dissection in hand-assisted laparoscopic radical gastrectomy

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

机构地区：[1]成都军区总医院胃肠外科,610083

出　　处：《中华普通外科学文献（电子版）》2016年第5期363-366,共4页Chinese Archives of General Surgery(Electronic Edition)

摘　　要：目的评价逆向卷席式淋巴结清扫术在手助腹腔镜胃癌D2根治术中应用的安全性和有效性。方法回顾性分析2013年1月至2014年12月间接受手助腹腔镜胃癌根治术的170例胃癌患者的临床资料。所有患者均采用逆向卷席式淋巴结清扫模式,即从手助腹腔镜下淋巴结清扫开始,清扫No.4sb→No.10/No.2/No.11d→No.11p→No.7/No.9→No.8a→No.1/No.3→No.5→No.12a组淋巴结;离断胃或者食管,将游离的胃和网膜组织移出腹腔之外,直视下清扫No.6组淋巴结。依据平均手术切口大小、手术时间、术中出血量、检获淋巴结数目和术后住院时间以及围手术期并发症,评价逆向卷席式手术的安全性和有效性。结果根治性远端胃切除术93例,全胃切除术63例,近端胃切除术14例。平均手术切口(6.97±0.10)cm;手术时间(176.40±30.88)min;检获淋巴结数目(25.21±14.33)枚;术中出血量(204.18±100.13)ml;术后住院时间(8.96±1.39)d。无一例手术死亡;手术并发症率4.12%。结论逆向卷席式淋巴结清扫术优化了手助腹腔镜胃癌根治术的手术流程,具有良好的肿瘤根治性及手术安全性,是一种值得借鉴的胃癌淋巴结清扫模式。Objective To evaluate the safety and efficacy of reverse rolling-mat type lymph nodedissection in hand- assisted laparoscopic surgery（HALS） of radical D2 gastrectomy. Methods Theclinical data of one hundred and seventy patients with gastric cancer, who were treated in the Departmentof Gastrointestinal Surgery, Chengdu Military General Hospital between January 2013 and December2014, were analyzed retrospectively. All patients were performed the reverse rolling-mat type technicalapproach for lymph node dissection, with the order of the lymph node dissection from Group 4sb, 10, 2,11 d, 11 p, 7, 9, 8a, 1, 3 to Group 5 and 12 a. After the stomach or esophagus was severed, the stomach andgreater omentum were pulled out of the abdominal cavity, and the Group 6 lymph node was completelyresected under direct visualization. The safety of the operation was evaluated on the basis of the averageincision size, operation time, intraoperative blood loss, the number of lymph node dissected and length ofhospital stay and perioperative complications after surgery. Results 93 cases underwent radical distalgastrectomy, 63 cases radical total gastrectomy, and 14 cases were given radical proximal gastrectomy.Mean incision length was（6.97±0.10） cm; operation time was（176.40±30.88） min; the number of dissectedlymph node was（25.21 ± 14.33）; intraoperative bleeding level was（204.18 ± 100.13） ml; postoperativehospital stay was（8.96 ± 1.39） d. There was no death during operation. The incidence of postoperativecomplications was 4.12%. Conclusion The reverse rolling-mat type lymph node dissection has betterradical efficacy of tumor resection and safety of operation, which might become a new procedure of hand-assisted laparoscopic surgery for gastric cancer surgery.

关 键 词：胃肿瘤 胃切除术 淋巴结切除术 手控腹腔镜检查术 

分 类 号：R735.2[医药卫生—肿瘤]