保留胰腺、清除脾动脉干淋巴结的胃癌切除术

Resection of gastric carcinoma with preservation of the pancreas and clearance of lymph nodes along the splenic artery

目的 通过研究胃的淋巴引流和胰腺血供 ,设计胃癌切除保留胰腺、清除脾动脉干淋巴结的手术方法。方法 在胃癌切除术中 ,从贲门浆膜下注入亚甲蓝 2ml,观察胃的淋巴流向 5 4例。回顾性分析本院 1961～1986年间能切除的 4 3 9例胃贲门、胃体部癌和全胃癌浸润胰腺情况。结果 胃的淋巴不引流入胰实质内。胃癌浸润胰腺机会不多 ,本组共 2 5例 ,占 5 7% (2 5 /4 3 9)。切除脾动静脉、胰被膜及其周围淋巴结、脂肪结缔组织后 ,不致引起胰体尾坏死。保胰法术后发生并发症 9例 (9/2 16,4 2 % ) ,显著低于切胰法 12例 (12 /3 0 ,4 0 % ) ,P <0 0 1。结论 保胰法的优点为手术操作并不困难 ,且能彻底清除脾动脉干淋巴结 ,术后并发症发生率和糖尿病发生率低。

Objective Based on the research of the gastric lymphatic drainge and the pancreatic blood supply,a new operative procedure for gastric cancer with preservation of the pancreas and clearance of lymph nodes along the splenic artery was designed.Methods (1)During the process of gastrectomy 2 ml of methylene blue was injected into the subserosal space of the cardia to observe the direction of lymphatic flow of the stomach in 54 cases.(2)The pancreatic involvement was retrospectively reviewed among 439 cases admitted from 1961 to 1986 with resectable carcinoma of the gastric cardia,gastric corpus and total stomach.(3)The blood supply of the body and tail of the pancreas was studied.Results (1)The lymph flow from the stomach did not enter the pancreas.(2)Invasion of gastric cancer into pancreas occurred in only 25 cases (5.7%).(3)Necrosis of the pancreatic body and tail did not ensue as a result of resection of splenic artery and vein.(4)Postoperative complications of pancreatic preservation occurred in 9 cases (4.2%) which was lower than that of 12 cases (40%) undergoing concomitant pancreatic resection ( P <0 01).Conclusions The procedure of pancreatic preservation has the advantage of easier performance,complete clearance of lymph nodes along the splenic artery,and low incidence of postoperative complication and diabetes mellitus,at the same time the 5-yr survival rate was higher than that of the pancreatic resection procedure.