胰后入路保留胰脾的原位脾门淋巴结清扫在腹腔镜胃癌根治术中的应用

Laparoscopic pancreas- and spleen-preserving splenic hilar lymph nodes dissection through retropancreatic approach in radical gastrectomy for advanced gastric cancer

中上部胃癌患者在行胃癌切除＋D2淋巴结清扫术时，应常规清扫沿脾动脉旁（第11组）和脾门淋巴结（第10组）。但由于手术操作的复杂性，很多手术是通过联合远端胰腺、脾脏的切除而实现。但是，联合胰腺、脾脏切除并未显著提高患者的术后生存率，反而增加患者术后并发症的发生率以及病死率。

Laparoscopic pancreas- and spleen-preser- ving splenic hilar lymph nodes dissection is still difficult to accomplish, which restrains its application in total gastrectomy for advanced proximal gastric cancer. Based on our anatomical understanding of pre- and retropancreatic spaces, features of splenic vessels and distribution of perigastric lymph nodes, we combined the characteristics of laparoscopic surgery and developed a novel technique for laparoscopic pancreas- and spleen-preserving splenic hilar lymph nodes dissection through retropancreatic space. The key lies in mobilization of the splenic pedicle through retropancreatic space, dissection of peri-vascular lymph nodes in sequence of trunk-to-branch, in-sheath vascular- ization of the splenic vessels. From August 2009 to December 2010, this technique was performed on 6 patients in Nanfang hospital. The initial results suggested that this technique could be safe and feasible for skillful surgeons. Further studies on the application of this technique in total gastrectomy for advanced proximal gastric cancer would be needed.