解剖定位标志在腹腔镜远端胃癌D2根治术中的应用体会

Application of Anatomic Marks in Laparoscopic Surgery for Radical Treatment of Gastric Cancer

目的：探讨解剖定位标志在腹腔镜远端胃癌根治术中的意义，以及利用解剖定位标志在腹腔镜下实施胃癌根治术的正确方法和技巧。方法：通过对6具成人尸体标本进行腹腔镜胃癌根治模拟手术及解剖，观察远端胃癌D2根治术中可供利用的镜下解剖学定位标志；对20例病人行腹腔镜远端胃癌根治术治疗。结果：解剖观察发现，胰腺、结肠中血管、胃左血管、肝胰襞位置恒定而突出，在腔镜下易于识别，可作为腹腔镜下手术的定位标志。20例在腹腔镜下完成D2根治手术，手术清扫的淋巴结数目为11—32个。结论：借助于镜下可利用的解剖定位标志进行胃癌根治手术，可引导手术在正确的位置和层面进行解剖分离，更符合安全性的原则和肿瘤根治的规范。

Objective：To evaluate the significance of anatomic marks in laparoscopic surgery, and provide correct approaches and skills for radical treatment of gastric cancer by laparoscopic surgery. Methods ： Six formalin fixed cadavers were dissected, and the anatomic marks from laparoscopie vision in the radical treatment of gastric cancer were observed. Furthermore, the radical operation of gastric cancer by laparoseopy was performed on 20 cases. Results ： Pancreatic gland, medium vessels of colon, left gastric vessels, and hepatopancreatic fold could be served as marks in laparoscopic surgery for their constant and obvious positions, which can be recognized easily under laparoscope. Twenty patients accepted the radical operation with help of a laparoscope. Meanwhile, 11 - 32 lymph nodes were scavenged. Conclusions ： The anatomic marks in laparoscopic surgery＇for radical treatment of gastric cancer could guide us to operate in the right space and proper anatomical layer, so that the operation will more meet the requirements of safety and principle for radical treatment of carcinoma.