基于双向解剖的选择性保留胃网膜右血管第一分支在腹腔镜胃癌保留幽门手术中的可行性分析  

Analysis of feasibility of selectively preserving the first branch of the right gastro-omental artery using bidirectional dissection in laparoscopic pylorus-preserving gastrectomy

作　　者：叶泽耀 俞鹏飞[1] 曹阳 柴腾蛟 张斌忠 司马军[3] 王兵[1] 江智辉 余平元 吴伟星 杜义安[1] Ye Zeyao;Yu Pengfei;Cao Yang;Chai Tengjiao;Zhang Binzhong;Sima Jun;Wang Bing;Jiang Zhihui;Yu Pingyuan;Wu Weixing;Du Yi'an(Department of Gastric Surgery,Zhejiang Cancer Hospital,Hangzhou 310022,China;Department of Gastrointestinal Surgery,Jiaxing Second Hospital,Jiaxing 314051,China;Department of Gastrointestinal Surgery,Hangzhou Red Cross Hospital,Hangzhou 310030,China;Wenzhou Medical University,Wenzhou 325035,China)

机构地区：[1]浙江省肿瘤医院胃外科,杭州310022 [2]嘉兴二院胃肠外科,嘉兴314051 [3]杭州市红十字会医院胃肠外科,杭州310030 [4]温州医科大学,温州325035

出　　处：《中华胃肠外科杂志》2024年第8期840-845,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：浙江省自然基金重点项目(LBZ22H160002)。

摘　　要：目的:探讨基于双向解剖的选择性保留胃网膜右血管第一分支,在腹腔镜胃癌保留幽门手术(LPPG)中的安全性与可行性。方法:采用描述性病例系列研究方法。回顾性收集自2018年2月至2023年8月期间浙江省肿瘤医院胃外科(28例)、嘉兴二院胃肠外科(1例)和杭州红十字会医院胃肠外科(1例)收治,并根据胃网膜右血管及幽门下血管在幽门袖的分布情况而行选择性保留胃网膜右血管第一分支LPPG治疗的30例胃中部早期胃癌患者临床资料。主要观察:(1)术中保留胃网膜右血管第一分支情况;(2)整体手术情况;(3)术后造影和内镜检查所见。结果:30例患者均成功实施选择性保留胃网膜右血管第一分支的LPPG手术。手术时间(244.3±29.3)min;中位术中出血量50(20~200)ml;中位肿瘤最大径1.2(0.5~3.6)cm,淋巴结清扫数量(32.3±11.6)枚;中位阳性淋巴结0(0~6)枚;清扫No.6淋巴结(5.1±1.5)枚;术后恢复进食时间(5.2±0.5)d;术后住院时间(8.4±3.4)d;术后病理T分期T1a、T1b和T2分别有14、10和6例;30例患者分别于术后5 d(28例)和9 d(2例)造影,提示小肠显影良好;无胃排空延迟病例,1例(3.3%)出现腹腔感染,保守治疗后痊愈。结论:选择性保留胃网膜右血管分支在LLPG治疗胃中部早期胃癌中安全可行。Objective:To assess the safety and feasibility of selectively preserving the first branch of the right gastro-omental artery using bidirectional dissection in laparoscopic pylorus-preserving gastrectomy(LPPG).Methods:In this retrospective analysis,we studied preoperative,intraoperative,postoperative,and follow-up data of 30 patients with early gastric cancer treated in the Department of Gastric Cancer in Zhejiang Cancer Hospital(28 patients),Department of Gastrointestinal Surgery in Jiaxing Second Hospital(one patient)and Department of Gastrointestinal Surgery in Hangzhou Red Cross Hospital(one patient)who had undergone selective preservation of the first branch of the right gastro-omental artery during LPPG.The main variables studied were as follows:(1)intraoperative preservation of the first branch of the right gastro-omental artery;(2)the overall surgical situation;and(3)postoperative small bowel follow-through and endoscopy findings.Results:LPPG with selective preservation of the right gastro-omental artery vascular branch was achieved in all 30 of the study patients.The mean operation time was(244.3±29.3)minutes and the median intraoperative blood loss 50(20–200)mL.The median tumor diameter was 1.2(0.5–3.6)cm and an average of 32.3±11.6 lymph nodes were dissected.The overall median number of positive lymph nodes was 0(0–6),and of No.6 lymph nodes 5.1±1.5.Postoperative feeding resumed at an average of 5.2±0.5 days and the postoperative hospital stay averaged 8.4±3.4 days.Pathological stages were as follows:T1a(14 cases),T1b(10 cases),and T2(6 cases).Small bowel follow-through imaging showed good results in 28 patients 5 days post-surgery,the remaining two exhibiting good results 9 days post-surgery.There were no instances of delayed gastric emptying,and only one patient(3.3%)developed intra-abdominal infection(resolved with conservative treatment).Conclusion:Selective preservation of the right gastro-omental artery during laparoscopic early gastric cancer surgery is a safe and feasible procedure fo

关 键 词：胃肿瘤 早期 腹腔镜保留幽门胃切除术 双向解剖 选择性保留胃网膜右血管第一分支 胃排空延迟 

分 类 号：R735.2[医药卫生—肿瘤]