胃十二指肠动脉入路法在腹腔镜下进展期胃下部癌No.5、No.12a组淋巴结清扫中的应用  

Application of Gastroduodenal Artery Approach in Laparoscopic No.5 and No.12a Lymph Nodes Dissection for Advanced Lower Gastric Cancer

作　　者：张俊立 韩广森 马鹏飞 曹养辉 刘晨宇 赵玉洲 Zhang Junli;Han Guangsen;Ma Pengfei(Department of General Surgery,Affiliated Tumor Hospital of Zhengzhou University(Henan Tumor Hospital),Zhengzhou 450000,China)

机构地区：[1]郑州大学附属肿瘤医院普外科,郑州450000

出　　处：《中国微创外科杂志》2020年第7期586-589,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨胃十二指肠动脉入路法在腹腔镜下进展期胃下部癌No.5、No.12a组淋巴结清扫中的安全性和有效性。方法2017年6月~2018年9月对60例胃下部癌采用胃十二指肠动脉入路法在腹腔镜下清扫No.5、No.12a组淋巴结,沿胃十二指肠动脉表面向上游离,显露胃右血管右侧壁;沿肝总动脉表面向上游离显露胃右血管左侧壁,根部离断胃右血管,完成No.5淋巴结清扫;紧贴门静脉左前壁小心钝性分离其表面淋巴脂肪组织至左、右肝管汇合处;离断十二指肠系膜,游离肝固有动脉表面附着脂肪淋巴组织至左右肝管汇合处,完成No.12a组淋巴结清扫。结果60例均顺利完成腹腔镜手术,无中转开腹。手术时间(150.6±26.8)min,术中出血量(42.6±16.5)ml。No.5、No.12a淋巴结清扫时间(5.8±3.8)min,淋巴结清扫数目(45.2±6.8)枚。清扫No.5组淋巴结131枚,平均2.2枚/例,其中转移淋巴结数为40枚,淋巴结转移度为30.5%;清扫No.12a组淋巴结252枚,平均4.2枚/例,其中转移淋巴结数为71枚,淋巴结转移度为28.2%。术后进食流食时间(2.6±1.2)d,术后住院时间(10.2±1.6)d。淋巴漏2例,均保守治疗后顺利出院;术后无胆漏、胆囊坏疽、胰漏、出血等并发症,术后30 d内无死亡病例。55例术后随访9~24个月,中位随访时间20个月,1例因冠心病死亡,4例因肿瘤复发或转移死亡,6例复发转移带瘤生存(4例腹膜后多发淋巴结转移,1例肝转移,1例肺转移),余44例未发现复发或转移。结论采用胃十二指肠动脉入路法腹腔镜下对进展期胃下部癌行No.5、No.12a组淋巴结清扫安全、可行。Objective To investigate the safety and efficacy of gastroduodenal artery approach in laparoscopic No.5 and No.12 a lymph nodes dissection for advanced lower gastric cancer. Methods From June 2017 to September 2018, 60 cases of lower gastric cancer were treated with gastroduodenal artery approach dissection of the lymph nodes of No.5 and No.12 a groups under laparoscope. The right wall of the right gastric vessel was exposed by ascending the surface of the gastroduodenal artery;the left wall of the right gastric vessel was exposed along the surface of the common hepatic artery, and the right gastric vessel was cut off at the root to complete the No.5 lymph node dissection;the lymph lipid tissue on the surface was carefully and bluntly separated from the left anterior wall of the portal vein to the confluence of the left and right hepatic ducts;the duodenal mesentery was severed to free the surface of the intrinsic hepatic artery with attached fatty lymphatic tissue to the confluence of the left and right hepatic ducts to complete the lymph node dissection of group No.12 a. Results All the 60 cases of laparoscopic operation were successfully completed without conversion to open laparotomy. The operation time was(150.6±26.8) minutes, the intraoperative blood loss was(42.6±16.5) ml, and the No.5 and No.12 a lymph node dissection time was(5.8±3.8) minutes. The number of lymph nodes dissected was 45.2±6.8. There were 131 lymph nodes in No. 5 group(mean, 2.2 lymph nodes per case), 40 of which were metastatic lymph nodes, and the lymph node ratio(LNR) was 30.5%. A total of 252 lymph nodes were collected in No. 12 a group(mean, 4.2 lymph nodes per case), 71 of which were metastatic lymph nodes, and the LNR was 28.2%. The time to fluid intake was(2.6±1.2) days, and the postoperative hospital stay was(10.2±1.6)days. Two cases of lymphatic leakage were successfully discharged after conservative treatment;no postoperative biliary leakage, gallbladder gangrene, pancreatic leakage, postoperative bleeding or other complic

关 键 词：胃下部癌 进展期 胃十二指肠动脉 腹腔镜 淋巴结 

分 类 号：R735.2[医药卫生—肿瘤]