顺向式模块化淋巴结清扫在腹腔镜胃癌手术中的应用  

Application of clockwise modularized lymphadenectomy in laparoscopic gastrectomy for gastric cancer

作　　者：胡建昆[1] 杨昆[1] 陈心足[1] 张维汉[1] 刘凯[1] 陈小龙[1] 赵林勇 周总光[1] Hu Jiankun Yang Kun Chen Xinzu Zhang Weihan Liu Kai Chen Xiaolong Zhao Linyong Zhou Zongguang(Department of Gastrointestinal Surgery, Institute of Gastric Cancer, West China Hospital, Sichuan University, Chengdu 610041, China)

机构地区：[1]四川大学华西医院胃肠外科中心胃癌研究室,成都610041

出　　处：《中华胃肠外科杂志》2017年第2期200-206,共7页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金（81301867）;四川省青年科技创新研究团队（2015TD0009）;四川大学华西医院学科卓越发展1·3·5工程项目

摘　　要：目的探讨顺向式模块化淋巴结清扫在腹腔镜胃癌手术中应用的可行性及有效性。方法回顾性分析2016年7～9月期间因胃癌行腹腔镜顺向式模块化淋巴结清扫的19例患者（顺向式淋巴结清扫组）临床资料。顺向式模块化淋巴结清扫即固定的手术顺序、具体的操作步骤和细节以及清扫淋巴结的要求，具体主要体现在两方面，一则通过悬吊肝脏、束扎网膜，改善术野的暴露，方便淋巴结的清扫；二则提出每组淋巴结清扫的注意事项及要求，使腹腔镜胃癌D2淋巴结清扫更易质控。将顺向式淋巴结清扫组患者的手术结果包括手术时间、手术相关并发症、术中出血量、总的清扫淋巴结数目、术后并发症及术后恢复情况等与2016年1—7月期间行腹腔镜传统淋巴结清扫术的19例胃癌患者（传统淋巴结清扫组）进行比较。结果顺向式淋巴结清扫组和传统淋巴结清扫组患者基线资料的比较，差异均无统计学意义（P〉0．05）。所有患者均成功施行腹腔镜手术，无中转，无术中并发症。顺向式淋巴结清扫组与传统淋巴结清扫组比较，手术时间[（278．4±29．9）min比（296．7±3013）min]、术中出血量[（91．1±41．6）ml比（102．2±32．2）ml]和淋巴结送检数[（38．2±15．1）枚比（37．0±12．3）枚]差异均无统计学意义（均P〉0．05）；但顺向式淋巴结清扫组No．11p淋巴结清扫数为（2．2±1．8）枚，传统淋巴结清扫组为（0．8±1．0）枚，两组差异有统计学意义（P=0．013）。两组术后各有4例（21．0％）患者并发肺部感染，经抗炎治疗后痊愈；均无吻合口瘘、腹腔出血、腹腔感染、肠梗阻等并发症发生。结论顺向式模块化淋巴结清扫有助于腹腔镜胃癌手术中的牵拉及暴露，可减少手术时间，减轻腹腔镜胃癌手术中的出血．有助于更彻底地清扫淋巴结，尤其是腹腔干周围淋巴结清�Objective To investigate the feasibility and efficacy of clockwise modularized lymphadenectomy in laparoscopic gastrectomy for gastric cancer. Methods Clinical data of 19 cases who underwent the laparoscopic clockwise modularized lymphadenectomy for gastric cancer （clockwise group） from July 2016 to September 2016 were analyzed retrospectively. The clockwise modularized lymphadenectomy included the fixed operative order, detailed procedure and requirement of lymphadenectomy, which mainly reflected in assisting the exposure of operative field and dissection of lymph nodes through suspending the liver and banding the greater omentum, as well as proposing the requirements and attentions for the dissections of each station of lymph nodes to facilitate the quality control of lymphadenectomy. The operative time, intraoperative complications, intraoperative estimate blood loss, number of total harvested lymph nodes, morbidity and postoperative recovery, were compared with the data of another 19 cases who received traditional lymphadenectomy from January 2016 to June 2016 （control group）. Results The baseline data were comparable between two groups. All the patients were performed successfully by laparoscopy without conversion and intraoperative complications. The operative time, intraoperative estimated blood loss and number of total harvested lymph node were （278.4± 29.9） min, （91.1 ± 41.6） ml and 38.2 ± 15.1 in clockwise group, and were （296.7± 30.3） min, （102.2 ± 32.2） ml and 37.0±12.3 in control group without significant differences （all P 〉 0.05）. However, the mean number of retrieved No.llp lymph nodes was 2.2±1.8 in clockwise group, which was significantly higher than that in control group （0.8 ± 1.0） （P = 0.013）. Four patients in each group suffered from pulmonary infections, who were cured by conservative therapies. There was no anastomotic leakage, intraperitoneal hemorrhage, intraperitoneal infection or intestinal obstruction in each group. Conclusion The clockwis

关 键 词：胃肿瘤 腹腔镜手术 淋巴结清扫 顺向式 模块化 

分 类 号：R735.2[医药卫生—肿瘤]