腹腔镜下“四步法”脾门淋巴结清扫术在进展期近端胃癌中的应用  

Application of laparoscopic"four-step method"splenic hilar lymph node dissection in advanced proximal gastric cancer

作　　者：姚富强 杨成城 李帅鹏 范青文 吴超飞 杨展鹏 吴刚 张超 YAO Fuqiang;YANG Chengcheng;LI Shuaipeng(Department of Gastrointestinal Surgery,Zhengzhou University People's Hospital,Henan Provincial People's Hospital,Zhengzhou 450003,China)

机构地区：[1]郑州大学人民医院,河南省人民医院胃肠外科,河南郑州450003

出　　处：《腹腔镜外科杂志》2025年第1期23-27,共5页Journal of Laparoscopic Surgery

摘　　要：目的:探讨腹腔镜下“四步法”脾门淋巴结清扫术治疗进展期近端胃癌的安全性与可行性。方法:回顾分析2022年1月至2023年1月收治的35例进展期近端胃癌患者的临床资料,均行腹腔镜下根治性全胃切除术联合“四步法”保留脾脏的脾门淋巴结清扫术,分析患者术中、术后及并发症情况,术后通过电话及门诊方式进行随访,随访截至2024年1月。结果:35例患者均顺利完成脾门淋巴结清扫,手术时间平均(257±19)min;术中出血量平均(61±38)mL;No.10、11d淋巴结清扫时间平均(40±5)min,平均出血量(35±26)mL;35例患者淋巴结清扫总数为1357枚,平均清扫淋巴结(39±5)枚;No.10、N o.11d淋巴结清扫总数为90枚与57枚,淋巴结转移率分别为11.11%(10/90)与14.04%(8/57),No.10、No.11d淋巴结清扫数量平均(2.6±1.6)枚与(1.6±0.9)枚,转移率分别为25.71%(9/35)与22.86%(8/35)。术后首次排气时间(3.3±0.6)d,术后进流质饮食时间(4.3±0.7)d,术后平均住院(12±4)d。术后均未发生吻合口漏,Clavien-DindoⅠ级、Ⅱ级并发症发生率为17.14%(6/35)。术后根据病理结果予以规范化疗,35例患者均获得随访,随访期间无死亡,未发现肿瘤复发或转移。结论:腹腔镜全胃切除术中应用“四步法”脾门淋巴结清扫治疗进展期近端胃癌安全、可靠。Objective:To investigate the safety and feasibility of laparoscopic"four-step method"splenic hilar lymph node dissection in advanced proximal gastric cancer.Methods:A retrospective analysis was conducted on the clinical data of 35 patients with advanced proximal gastric cancer treated from Jan.2022 to Jan.2023.All patients underwent laparoscopic radical total gastrectomy with spleen-preserving splenic hilar lymph node dissection using the"four-step"method.The intraoperative,postoperative,and complication-related outcomes were analyzed in the patients.Postoperative follow-up was conducted via telephone and outpatient visits.The follow-up period ending was Jan.2024.Results:All patients successfully underwent splenic hilar lymph node dissection,and the mean operative time was(257±19)min,the average intraoperative blood loss was(61±38)mL;the dissection time for No.10 and No.11d lymph nodes was(40±5)min,and the average blood loss was(35±26)mL.A total of 1357 lymph nodes were dissected in 35 patients,the a verage number of lymph nodes dissected was(39±5),the total number of No.10 and No.11d lymph nodes dissected were 90 and 57,respectively,and the No.10 and No.11d lymph node metastatic rates were 11.11%(10/90)and 14.04%(8/57),respectively.The average number of No.10 and No.11d lymph nodes dissected were(2.6±1.6)and(1.6±0.9),respectively,and metastatic rates were 25.71%(9/35)and 22.86%(8/35),respectively.The time to first flatus postoperatively was(3.3±0.6)d,the time to start consuming liquid food was(4.3±0.7)d,and the average hospital stay was(12±4)d.No anastomotic leakage occurred postoperatively,and the Clavien-Dindo gradeⅠandⅡcomplication rate was 17.14%(6/35).Postoperatively,all patients received standardized chemotherapy based on pathological results,and all patients were followed up,with no deaths,tumor recurrence,or metastasis observed during the follow-up.Conclusions:The laparoscopic"four-step method"for splenic hilar lymph node dissection in total gastrectomy for the treatment of advanced proxima

关 键 词：胃肿瘤 全胃切除术 腹腔镜检查 脾门 淋巴结切除术 

分 类 号：R735.2[医药卫生—肿瘤]