局解手术学杂志2018，Vol.27Issue(4)：270-275,6.DOI:10.11659/jjssx.01E018029
托出式胰后入路脾门淋巴结清扫在腹腔镜胃癌根治术中的临床应用
Laparoscopic spleen-preserving splenic hilar lymph nodes dissection through retropancreatic and extruded approach in radical gastrectomy for advanced gastric carcinoma
摘要
Abstract
Objective To investigate the feasibility and safety of laparoscopic spleen-preserving splenic hilar lymph nodes dissection through retropancreatic and extruded approach in radical gastrectomy for proximal gastric carcinoma,and to preliminarily analyzed the anatom-ical features.Methods Adopted a retrospective cohort study.The clinical data of 84 patients with proximal gastric carcinoma who underwent radical resection in our hospital from June 2014 to January 2017 were collected.Among the 84 patients,44 case who underwent spleen extru-ded-retroperitoneal approach were regarded as the observation group,and the other 40 patients underwent conventional left approach were allo-cated into the control group.All the patients underwent laparoscopic D 2 radical total gastrectomy and spleen-preserving N0.10 nodes dissec-tion by the same operation team.The clinical situation of the two groups before operation,after operation and during the follow-up were ob-served.Results All the 84 patients successfully completed the radical gastrectomy without conversion to open surgery.In the observation group and the control group,the volume of intraopertative blood loss were respectively(107.9 ±52.9)mL and(153.1 ±72.2)mL;the opera-tion time were respectively(228.8 ±27.7)min and(244.7 ±31.3)min;the number of dissected N0.10 lymph node were respectively(5.0 ± 2.2)and(2.9 ±1.3).There were statistically significant differences in all the above indexs(P<0.05).In the observation group and the control group,the time for initial out-of-bed activity were respectively(1.6 ±0.4)days and(1.5 ±0.4)days;the time of initial anal exsuffla-tion were respectively(2.9 ±0.8)days and(2.6 ±0.5)days;the duration of hospital stay were respectively(7.5 ±1.4)days and(7.0 ± 1.3)days.Postoperative complications occured 4 cases in the observation group and 5 cases in the control group.There was no statistically significant difference in terms of time for initial out-of-bed activity,time of initial anal exsufflation,duration of hospital stay and postoperative complications(P>0.05).A total of 82 patients were followed up for 6 to 36 months,with a median time of 15.5 months.Conclusion Compared with the conventional left approach,laparoscopic spleen-preserving splenic hilar lymph nodes dissection through retropancreatic and extruded approach is safe and feasible for laparoscopic radical resection of proximal gastric carcinoma.And it can shorten the operation time, reduce the volume of intraopertative blood loss,and increase the clearance of N0.10 lymph nodes.关键词
胃癌/淋巴结清扫/胰后入路/托出式Key words
gastric carcinoma/lymph nodes dissection/retropancreatic approach/extruded approach分类
医药卫生引用本文复制引用
刘世呈,吴淼,刘见,杨晓波,熊莉..托出式胰后入路脾门淋巴结清扫在腹腔镜胃癌根治术中的临床应用[J].局解手术学杂志,2018,27(4):270-275,6.基金项目
宜宾市重点科技项目(2013SF001) （2013SF001）
