腹腔镜胃癌根治术关键技术标准及评价  

The key technical standards and evaluation of laparoscopic radical gastrectomy for gastric cancer

作　　者：余江[1] 李国新[1] YU Jiang;LI Guo-xin(Department of General Surgery,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院普外科,广东广州510515

出　　处：《中国实用外科杂志》2024年第1期61-65,共5页Chinese Journal of Practical Surgery

基　　金：广东省胃肠肿瘤精准微创诊疗重点实验室项目(No.2020B121201004);南方医科大学南方医院临床研究专项(No.2021CR001,No.2021CR013)。

摘　　要：腹腔镜胃癌根治术是一种微创、精准的手术方式,经过近30年的探索和努力,已经成为中下部早期胃癌的标准治疗手段,同时适应证也逐渐扩大到进展期胃癌、全胃切除、近端胃切除、食管胃结合部癌等领域。腹腔镜胃癌根治术的关键技术步骤包括戳孔的布局和建立气腹、探查和脱落细胞学检测、淋巴规范清扫、切缘判断及消化道重建、标本处理及淋巴结挑拣等,应遵循相应的质量控制和评价标准。目前针对腹腔镜胃癌根治术的各项临床研究,如CLASS、KLASS、JCOG等,以及相关专家共识和指南,为推动我国腹腔镜胃癌外科的规范化和标准化提供了参考和借鉴。机器人手术、3D腹腔镜手术、荧光腹腔镜等技术的进步,以及保功能手术的兴起,代表着目前腹腔镜胃癌根治术的创新发展方向,期待未来开展更多规范化临床研究,以解决争议的临床问题,提高我国腹腔镜胃癌外科的诊疗水平。Laparoscopic radical gastrectomy is a minimally invasive and precise surgical approach.Over nearly 30 years of exploration and efforts,it has become the standard treatment for early gastric cancer in the lower and middle parts of the stomach.Additionally,its application has gradually expanded to include advanced-stage gastric cancer,total gastrectomy,proximal gastrectomy,and esophagogastric junction cancer.The key technical steps of laparoscopic radical gastrectomy involve trocar layout and establishment of pneumoperitoneum,exploration with cytological examination of shed cells,standardized lymphadenectomy, margin assessment, digestivetract reconstruction, specimen handling, and lymph noderetrieval, all guided by corresponding quality control andevaluation standards.Presently, various clinical studies onlaparoscopic radical gastrectomy, such as CLASS, KLASS,JCOG, along with relevant expert consensus and guidelines,serve as references for standardization and normalization oflaparoscopicgastric cancer surgery in our country.Advancements in robotic surgery , 3D laparoscopy, fluorescentlaparoscopy, and the rise of organ- preserving proceduresrepresent the innovative directions in the current developmentof laparoscopic radical gastrectomy.Expectations lie inconducting more standardized clinical research in the future toaddress contentious clinical issues and elevate the diagnosticand therapeutic standards of laparoscopic gastric cancersurgery in our country.

关 键 词：腹腔镜 胃癌根治术 淋巴结清扫 机器人手术 精准外科 

分 类 号：R6[医药卫生—外科学]