腹腔镜胃癌根治术中No.16淋巴结清扫价值及技术要点  

The clinical significance and technical points of No.16 lymph node dissection in laparoscopic radical gastrectomy for gastric cancer

作　　者：宋武[1] 汪晓峰 SONG Wu;WANG Xiao-feng(Department of Gastrointestinal Surgery,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院胃肠外科,广东广州510080

出　　处：《中国实用外科杂志》2023年第9期1012-1015,共4页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金项目(No.81871908);广东省自然科学基金项目(No.2018A030313715);广东省自然科学基金项目面上项目(No.82070529);广州市科技计划项目(No.201904010036)。

摘　　要：D2淋巴结清扫是局部进展期胃癌(LAGC)的标准手术方式,但关于LAGC病人是否行腹主动脉旁淋巴结(No.16淋巴结)清扫(PAND)仍存在争议。对于局限于No.16a2、No.16b1淋巴结转移、不伴有其他非治愈因素的LAGC病人,经多学科讨论,筛选出PAND的获益人群,在新辅助治疗有效的前提下,建议行扩大D2+PAND,以期达到R0切除。随着腹腔镜技术的快速发展,临床研究结果现已证实,在进展期胃癌病人中,腹腔镜手术的安全性及效果不亚于开放手术,故腹腔镜下PAND的手术也具有一定的临床应用前景。对于伴有No.16淋巴结转移的LAGC病人,如何合理地选择治疗模式及规范地开展腹腔镜下PAND手术仍然是外科医生面临的挑战。D2 lymph node dissection is the standard surgery of Local advanced gastric cancer(LAGC).However,the value of para-aortic lymph node dissection(PAND)in LAGC patients remains controversial.For LAGC patients limited to No.16a2and No.16b1 metastasis without other non-curative factors,through multidisciplinary consultation,evaluation and discussion should be performed.After screening out para-aortic lymph nodes dissection(PAND)benefit groups,D2+PAND should be expanded to achieve R0 removal after receiving neoadjuvant therapy.With the rapid development of laparoscopic technology,clinical researches have confirmed that the effect of laparoscopic surgery is no less than that of open surgery in patients with advanced gastric cancer.Therefore,laparoscopic LAGC surgery also has certain clinical application prospects.However,for LAGC patients with NO.16 lymph node metastasis,rationally selecting treatment mode and normalizing laparoscopic PAND surgery is still a challenge for clinicians.

关 键 词：胃癌 腹腔镜 腹主动脉旁淋巴结 淋巴结清扫 

分 类 号：R6[医药卫生—外科学]