胃癌腹腔镜下保脾的脾门淋巴结清扫术相关并发症的预防和处理  

Prevention and management of complications related to laparoscopic spleen-preserving hilar lymph node dissection for gastric cancer

作　　者：黄泽宁[1] 郑长悦 陆俊[1] 黄昌明[1] Huang Zening;Zheng Changyue;Lu Jun;Huang Changming(Department of Gastric Surgery,Fujian Medical University Union Hospital,Fuzhou 350001,China;Department of Gastrointestinal Surgery,the Affiliated Hospital of Putian University,Putian 351100,China)

机构地区：[1]福建医科大学附属协和医院胃外科,福州350001 [2]莆田学院附属医院胃肠外科,莆田351100

出　　处：《中华胃肠外科杂志》2023年第2期132-137,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：“福建省医疗“创双高”建设经费资助”(闽卫医政〔2021〕76号)。

摘　　要：脾门淋巴结转移是胃上部癌患者不良预后的危险因素之一,腹腔镜下保脾的脾门淋巴结清扫(LSPSHL)能有效使脾门淋巴结转移高危人群生存获益。然而,LSPSHL手术难度大,仍是胃上部癌根治术中富有挑战的手术难点,加之脾门区解剖位置深在、血管错综复杂,若操作不当也容易导致脾血管损伤、脾脏损伤和胰腺损伤等相关并发症。因此,在预防和处理LSPSHL相关并发症方面,首先应以预防为主,明确手术适应证,个体化选择LSPSHL获益人群,从而避免过度清扫所带来的风险;其次,在LSPSHL围手术期中,应提高对相关危险因素的认知,在良好的术野暴露和正确的解剖层面中规范而精准操作,尽可能避免周围组织器官的损伤所带来的风险,并掌握处理相关并发症的手术技巧和有效措施,从而提高LSPSHL的手术安全性。Hilar splenic lymph node metastasis is one of the risk factors for poor prognosis in patients with proximal gastric cancer.Laparoscopic spleen-preserving splenic hilar lymph node dissection(LSPSHLD)can effectively improve the survival benefits of patients at high risk of splenic hilar lymph node metastasis.However,LSPSHLD is still a challenging surgical difficulty in radical resection of proximal gastric cancer.Moreover,improper operation can easily lead to splenic vascular injury,spleen injury and pancreatic injury and other related complications,due to the deep anatomical location of the splenic hilar region and the intricate blood vessels.Therefore,in the prevention and treatment of LSPSHLD-related complications,we should first focus on prevention,clarify the indication of surgery,and select the benefit group of LSPSHLD individually,so as to avoid the risk caused by over-dissection.Meanwhile,during the perioperative period of LSPSHLD,it is necessary to improve the cognition of related risk factors,conduct standardized and accurate operations in good surgical field exposure and correct anatomical level to avoid surrounding tissues and organs injury,and master the surgical skills and effective measures to deal with related complications,so as to improve the surgical safety of LSPSHLD.

关 键 词：胃肿瘤 腹腔镜 脾门淋巴结清扫 保脾 并发症 

分 类 号：R735.2[医药卫生—肿瘤]