保留自主神经的胃癌D2淋巴结清扫技术

Surgical techniques of autonomic nerve preservation in lymph nodes dissection for gastric cancer

近年来，随着高级别循证医学研究成果的问世以及辅助治疗的规范化，胃癌手术由追求高度根治性的扩大手术为主流的时期，逐步转向以D2淋巴结清扫为中心的规范化、个体化的外科治疗时期。

Resection of the automonic nervous system in the process of lymph nodes dissection is a major factor leading to postoperative gastrointestinal dysfunction. The era of blind expansion of the wide excision has been questioned, and safety first, radical dissection of the metastatic lymph nodes, low inva- sire rate and organ function-saving surgery have been highly em- phasized. Preserving the gastric autonomic nerve effectively re- duces postoperative diarrhea, shortens the time for weight recov- ery, and prevents insulin secretion disorders and postoperative cholelithiasis. In the process of laparoseopie or open autonomic nerve preservation in lymph node dissection for gastric cancer, full understanding of the anatomy of the autonomic nervous sys- tem, recognizing the landmark of the nerves, proper designing the surgical space, dissecting according to the extraeellular space in the membrane of the nerve fibers and nerve plexus are factors which ensures the quality and effects of the surgery.