腹腔镜胃癌根治术中幽门下区淋巴结清扫的矢状位解剖学思路  

Anatomical ideas on infrapyloric lymphadenectomy in sagittal view of laparoscopic radical gastrectomy for gastric cancer

作　　者：王大广[1] 国瑀辰 孙璇[1] 李伟[1] 张洋[1] 所剑[1] Wang Daguang;Guo Yuchen;Sun Xuan;Li Wei;Zhang Yang;Suo Jian(Department of Stomach Colorectal Anal Surgery,The First Hospital,Jilin University,Changchun 130021,China)

机构地区：[1]吉林大学第一医院胃结直肠肛门外科,长春130021

出　　处：《中华胃肠外科杂志》2018年第8期896-900,共5页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的初步探讨腹腔镜胃癌根治术中幽门下区淋巴结清扫的矢状位解剖学思路。方法回顾性总结分析于2015年6月至2016年12月期间在吉林大学第一医院胃结直肠肛门外科接受胃癌D：根治术治疗的98例胃中下部癌患者的临床资料，男性56例，女性42例；平均年龄59岁；胃癌TNM分期：Ⅰ期22例，Ⅱ期37例，Ⅲ期39例。所有患者都进行了规范的第6组淋巴结清扫，Ⅱ期以上的患者同时还清扫了第14v组淋巴结。术中对胃幽门下区按照矢状位解剖学思路进行分亚区的淋巴结清扫，每个亚区的清扫以暴露相应的解剖标志为质量控制标准。胃幽门下区域被胰腺前平面和胃十二指肠动脉分成上、下两部分，下部是6v的区域，上部是6a与6i的区域，下部又被网膜右静脉分成前、后两部分，上部被网膜右动脉和幽门下动脉分为前、中、后3个部分，总共5个区域；幽门下区的淋巴结清扫即按着这5个区域分次进行。术中留取照片，并对手术时间及幽门下区淋巴结收获情况进行统计。结果22例Ⅰ期胃癌患者清扫第6组淋巴结时的幽门下区手术时间（38±6）min：76例Ⅱ、Ⅲ期胃癌患者清扫第6组及第14v组淋巴结时的幽门下区手术时间（49±8）min。拣获第6组淋巴结（5．4±2．9）枚，其中第6a组淋巴结（2．9±1.8）枚，第6v组淋巴结（1．3±0．9）枚，第6i组淋巴结（1．2±0．7）枚；有29例（29．6％）发现第6组淋巴结转移；9例（9．2％）发现第14v组淋巴结转移。结论基于胚胎发育学以及膜解剖学知识．对幽门下区分亚区进行淋巴结清扫，可以保证淋巴结清扫的质量，实现对第6组淋巴结的完整切除。Objective To preliminarily discuss the anatomical ideas on infrapyloric lymphadenectomy in the sagittal view of laparoscopic radical gastrectomy for gastric cancer. Methods A retrospective review was performed on the clinical data of 98 patients of lower-middle stomach cancer who underwent D2 radical gastrectomy in Department of Gastrointestinal Surgery of The First Hospital of Jilin University from June 2015 to December 2016. There were 56 males and 42 females with an average age of 59 yeats. TNM staging of gastric cancer revealed 22 cases of＂ stage I , 37 cases of stage lI , and 39 cases of stagem. All the patients underwent standardized No.6 lymph node dissection. Patients in stage II and above also received dissection of No.14v lymph nodes. During operation, sub- regional lymph node dissection was performed in the infrapylorie region according to sagittal anatomy. The dissection of each sub-region was to expose the conesponding anatomical landmarks as qualitycontrol standards. The region under the stomach pylorus was divided into the upper and lower parts by the pancreatic anterior plane and the gastroduodenal artery. The lower part was 6v region, and the upper part was 6a and 6i region. The lower part was further divided into front region and rear region by right vein of gastric omentum. The upper part was further divided into front, middle and posterior parts by right vein of gastric omentum and inferior pyloric artery. A total of 5 regions were established. Lymph node dissection in the lower pyloric region was performed at these five regions. Photographs were taken during operation and statistics was carried out in operation time and harvested lymph nodes from infrapyloric lymphadenectomy. Results The time to complete No.6 lymph node dissection was （38±6） minutes for the 22 patients with stage I gastric cancer, and to finish No.6 and No.14v lymph node dissection was （49±8） minutes for the 76 patients with stage II and stage m gastric cancer. The mean number of harvested No.6 lymph nodes was 5.4

关 键 词：胃肿瘤 淋巴结清扫 淋巴结 幽门下 解剖学思路 

分 类 号：R735.2[医药卫生—肿瘤]