胃癌行D2根治术加No.12p和No.8p淋巴结清扫及网膜囊完整切除的单中心回顾性分析  

D2 radical resection of omental bursa and No.12p and No.8p for gastric carcinoma： a retrospectively analysis from a single center in China

作　　者：陈路川[1] 魏晟宏[1] 叶再生[1] 肖军[1] 曾奕[1] 王益[1] 林振孟 林志涛 陈小玲[1] 

机构地区：[1]福建医科大学附属肿瘤医院,福建省肿瘤医院胃肠外科,福州350014

出　　处：《中华胃肠外科杂志》2018年第2期196-200,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：国家临床重点专科建设项目（2013-2014）;福建省自然科学基金（2016J01436,2016J01514）;福建省卫生计生中青年骨干人才培养项目（2017-ZQN-18）;福建省卫生计生青年科研课题（2014-2-8.2017-1-13）

摘　　要：目的探讨胃癌行D2加No.12p及No.8p淋巴结清扫及网膜囊完整切除的安全性和可行性。方法回顾性总结2000年1月至2010年1月期间，福建医科大学附属肿瘤医院胃肠外科行D2加No.12p及No.8p淋巴结清扫及网膜囊完整切除的胃癌患者临床资料。病例纳入标准：（1）年龄18~90岁；（2）经病理学确诊胃癌，并行D2加No.12p、No.8p及网膜囊完整剥离手术；（3）病历资料和术后病理及随访资料完整；（4）经由同一主刀医师完成。排除其他胃恶性肿瘤及胃癌术后复发以及同时或异时性合并其他原发恶性肿瘤者。手术操作要点：（1）切开十二指肠降部外侧的腹膜，该层浆膜移行到胃结肠韧带的前叶。（2）将胃结肠韧带和横结肠系膜的后叶钝性分开，向左侧进行分离到达大网膜附着于结肠部分，在大网膜附着于横结肠的边缘切开，并在胃结肠韧带后叶转向横结肠系膜前叶处开始向上，整块游离横结肠系膜的前叶。（3）分离胰腺被膜，并继续向上切除网膜囊的后壁，使网膜囊完整游离。沿肝下缘切开小网膜的附着处，到达食管前面，横行切开腹部食管的腹膜层，进而转向脾上极，从闭孔开始向食管方向切开后腹膜，此切开线为网膜囊切除的最上缘，将后腹膜切开缘向食管右缘翻转，与先前切除的小网膜后叶连在一起，沿食管右缘附着的后腹膜切断，并向下至腹腔动脉干处，切除网膜囊后壁。其间，切开肝十二指肠韧带，使门静脉、肝动脉和胆总管骨骼化，清扫该韧带内淋巴结。（4）清扫腹腔动脉及其主要分支的淋巴结，切除胰腺前面的包膜，胰上后腹的部分，游离脾和胰尾部分。结果1801例胃癌患者纳入分析。其中男性1292例（71.7%），男女比例为2.54∶1.00，年龄为（58.9 ± 11.5）（18~89）岁。肿瘤T1a、T1b、T2、T3、T4a和T4b分期的比例为4.8%（87例）、6.6%（118例）�ObjectiveTo evaluate the safty and feasibility of the D2 radical resection of omental bursa and No.12p and No.8p for gastric carcinoma （GC） .MethodsClinical data of 1801 GC patients undergoing D2 radical resection of omental bursa and No.12p and No.8p at Fujian Medical University Cancer Hospital from January 2000 to January 2010 were analyzed retrospectively. Inclusion case criteria： （1） age of 18 to 90 years; （2） pathologically diagnosed as GC and receiving D2 radical resection of omental bursa and No.12p and No.8p; （3） complete clinical, pathological and follow-up data; （4） operation performed by same leading surgeon; （5） exclusion of other gastric malignancies, postoperative relapse of GC, and other simultaneous or heterochronous primary malignancies. Surgical procedure points： （1） The outer part of the peritoneum of duodenum descending was cut; the serosa was migrated to the anterior leaf of the gastrointestinal ligament. （2） The posterior lobe of the gastrocolic ligament and the transverse mesocolon were separated bluntly from left side to reach the omentum attaching to the colon portion; incision was made at the edge of the omentum attaching to the transverse colon behind the gastrocolic ligament; the leaves were turned to the anterior mesenteric anterior leaflets, and the entire anterior leaflet of the transverse mesentery was free. （3） The pancreas was separated, and resection of the posterior wall of the omentum sac continued up so that the entire retinal capsule was free; along the edge of the liver the attachment of the omentum was cut to reach the front of esophagus, and transverse incision was made in abdominal peritoneal layer of the esophagus, and then turned to the spleen on the pole; from the obturator to the esophagus incision was performed behind the peritoneum for the net; the uppermost edge of the resection of the capsule was performed as the posterior peritoneal incision to the right edge of the esophagus and was connected with the posterior parietal l

关 键 词：胃肿瘤 根治度 D2+手术 5年生存期 

分 类 号：R735.2[医药卫生—肿瘤]