围歼式D_2淋巴结清扫在腹腔镜辅助远端胃癌根治术中的应用体会

The clinical analysis of the surround and annihilate-D2 lymph node dissection under the laparoscopic distal gastrectomy

目的:探讨围歼式D2淋巴结清扫在腹腔镜下远端胃癌根治术中的应用价值及临床效果。方法:回顾分析2009年12月至2011年12月为24例患者应用围歼式D2淋巴结清扫行腹腔镜辅助远端胃癌根治术的临床资料。淋巴结清扫过程不遵循沿肝总动脉清扫的原则,而是由外周正常组织开始清扫,逐渐显露不同的血管与分支。结果:本组24例手术均获成功,无一例中转开腹。术中出血量50～150 ml,平均(85±52)ml;淋巴结清扫数量12～32枚,平均(21±11)枚;淋巴结转移数量0～13枚,平均(7±4)枚;手术时间120～286 min,平均(186±50)min;首次术后排气时间平均(2.3±0.5)d,首次术后下地时间平均(1.2±0.6)d;切口长度平均(5.6±1.6)cm;平均住院(10.5±2.5)d。术后并发轻度高碳酸血症及淋巴漏各1例,均经治疗后痊愈。结论:腹腔镜下远端胃癌根治术中行围歼式D2淋巴结清扫是可行的,其清扫方法更符合肿瘤根治原则,且具有患者创伤小、康复快等优点。

Objective：To explore the clinical value and effect of the surround and annihilate-D2 lymph node dissection under the laparoscopic distal gastrectomy.Methods：The clinical data of 24 cases from Dec.2009 to Dec.2011 underwent the surround and annihilate-D2 lymph node dissection with the laparoscopic distal gastrectomy were retrospectively analyzed.Lymph node dissection does not follow the principle of cleaning along the common hepatic artery,but began to sweep from the peripheral normal tissues,gradually revealing various vascular branches.Results：All cases were performed successfully,no case was converted to open operation.Intraoperative blood loss was 50 to 150 ml,average（85±52） ml.The number of lymph node dissected was 12 to 32,average（21±11）.The number of lymph node metastasis was 0 to 13,average（7±4）.The operation time was 120 to 286 min,average（186±50） min.The average postoperative exhaust time was（2.3±0.5） d.The average postoperative ambulation time was（1.2±0.6） d.The average incision length was（5.6±1.6） cm,the average stay time was（10.5±2.5） d.Concurrent mild hypercapnia and lymphatic leakage was occurred in 1 case,who was cured after treatment.Conclusions：The surround and annihilate-D2 lymph node dissection under the laparoscopic distal gastrectomy is feasible,its cleaning method is more in line with the principle of radical tumor,and with less trauma,faster recovery.