基于系膜解剖的进展期胃上部癌腹腔镜左上腹区域系膜完整切除加脾门淋巴结清扫术的近期疗效分析  

Short-term efficacy evaluation of laparoscopic spleen-preserving splenic hilus lymphadenectomy and left epigastrium mesogastric excision for advanced proximal gastric cancer based on mesangial anatomy

作　　者：张云飞[1] 陈鹏[1] 孙建刚[1] 樊晓金 王依明 郜永顺[1] Zhang Yunfei;Chen Peng;Sun Jiangang;Fan Xiaojin;Wang Yiming;Gao Yongshun(Department of Gastrointestinal Surgery,The First Affiliated Hospital,Zhengzhou University,Zhengzhou 450001,China)

机构地区：[1]郑州大学第一附属医院胃肠外科,450001

出　　处：《中华胃肠外科杂志》2020年第2期177-182,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：吴阶平医学基金会(320.2710.1847)。

摘　　要：目的探讨基于系膜解剖的进展期胃上部癌腹腔镜左上腹区域系膜完整切除加脾门淋巴结清扫术的近期临床疗效。方法采用描述性病例系列研究方法。病例纳入标准:(1)患者术前经胃镜下活组织病理学检查证实为胃腺癌;(2)术前经腹部CT检查证实为局部进展期胃上部癌;(3)术前全身浅表淋巴结超声以及胸部和全腹部CT等检查无肝、肺、腹膜后淋巴结等远处转移,无肿瘤直接侵犯胰腺、脾脏、肝脏、结肠等;(4)行全胃或近端胃加D2淋巴结清扫术,且术后病理学证实为R0切除。排除标准:(1)术中腔镜探查见肿瘤腹腔播散或远处转移;(2)No.10淋巴结明显肿大或者融合成团;(3)病理学诊断资料不全。根据以上标准,回顾性收集2017年6月至2018年3月期间,于郑州大学第一附属医院胃肠外科行基于间隙解剖的进展期胃上部癌腹腔镜左上腹区域系膜完整切除+脾门淋巴结清扫术的36例患者的临床病理资料。本组患者年龄(59.8±8.0)岁,体质指数(23.9±3.5)kg/m2,术前化疗8例(22.2%)。分析患者术中、术后及并发症等情况。结果全组患者均成功施行腹腔镜脾门淋巴结及左上腹系膜清扫,在术后切除标本的检视中发现光整的胃上部后方系膜边界,均达到系膜完整切除的效果,无中转开腹者。淋巴结清扫和系膜切除总时间为(34.2±11.4)min,出血量为(44.8±21.3)ml。淋巴结清扫数目为(45.6±17.6)枚;No.11p+No.11d淋巴结清扫数目为(3.1±2.8)枚,其中7例(19.4%)发生淋巴结转移;No.10淋巴结清扫数目为(2.9±2.5)枚,其中2例(5.6%)发生淋巴结转移。术后首次排气时间为(3.8±0.6)d,拔除胃管时间为(1.9±0.7)d,首次进流质时间为(3.0±0.4)d,拔除引流管时间为(6.0±1.2)d,术后住院时间为(12.8±4.0)d。术后出现肺栓塞1例(2.7%),胃瘫1例(2.7%);术后并发症发生率为5.6%(2/36)。无手术部位感染、术后出血及术后30 d内死亡病例。中位随访时间为18(12~28)个Objective To investigate short-term efficacy of laparoscopic spleen-preserving splenic hilus lymphadenectomy and left epigastrium mesogastric excision for advanced proximal gastric cancer based on mesangial anatomy.Methods A case series study was carried out.Case inclusion criteria:(1)patient was confirmed as gastric adenocarcinoma by gastroscopic biopsy before operation;(2)locally advanced gastric cancer was confirmed by abdominal CT before operation;(3)no distant metastases such as liver,lung,and posterior peritoneal lymph nodes,and no tumor directly invading the pancreas,spleen,liver,and colon were verified by superficial lymph node ultrasound,chest and abdominal CT before operation;(4)total gastrectomy or proximal gastrectomy plus D2 lymphadenectomy were performed,and R0 resection was confirmed by postoperative pathology.Exclusion criteria:(1)intraperitoneal dissemination or distant metastasis was found during laparoscopic exploration;(2)No.10 lymph nodes were significantly enlarged or fused into clusters;(3)pathological diagnostic data were incomplete.According to above criteria,the clinicopathological data of 36 patients who underwent laparoscopic spleen-preserving No.10 lymphadenectomy and left epigastrium mesogastric excision based on interspace anatomy for advanced proximal gastric cancer in The First Affiliated Hospital of Zhengzhou University from June 2017 to March 2018 were retrospectively collected and analyzed.The intraoperative conditions,postoperative recovery and complications of patients were analyzed.Results In 36 patients,the mean age was(59.8±8.0)years,the mean BMI was(23.9±3.5)kg/m2,and 8 cases(22.2%)received preoperative chemotherapy.All the patients underwent successfully the laparoscopic spleen-preserving splenic hilus lymphadenectomy and left epigastrium mesogastric excision.In the examination of postoperative resected specimens,it was found that the mesangial boundary of the upper and posterior part of the stomach was smooth,indicating the efficiency of complete mesangial resection.N

关 键 词：胃肿瘤 腹腔镜检查 脾脏 胃系膜 

分 类 号：R735[医药卫生—肿瘤]