腹腔镜辅助下远端胃癌D2清扫入路的临床分析

Clinical analysis of laparoscopic D2 lymphadenectomy for distal gastric cancer

目的探讨腹腔镜远端胃癌D2淋巴结清扫入路的可行性及安全性。方法回顾性分析山西省人民医院普通外科2010年3月至2011年7月行腹腔镜辅助胃癌D，根治性切除的54例远端胃癌患者的临床资料。全组术中淋巴结廓清入路均遵循“胃结肠韧带→横结肠系膜前叶→胰腺被膜→4sb→4d→6→14v和8a→12a→9→7→11p及1→3→5→网膜囊”的次序，分析该廓清入路的可行性及肿瘤手术学结果的有效性。结果54例患者手术时间（236±51）min，术中失血量（217±65）ml；近端切缘间距（4．5±2．4）cm，远端切缘距离（5．0±3．0）cm，标本切缘均阴性；淋巴结摘除数目（18±5）枚，阳性淋巴结平均0～14枚。术后胃管停留时间（5±2）d，尿管停留时间（2±1）d，术后进食时间（8±2）d，术后住院时间（15±4）d。随访（11±3）个月，局部复发死亡3例（5．6％）。结论规范的腹腔镜远端胃癌D2外科清入路安全可行，手术肿瘤学结果达到了远端、近端无瘤残余的要求。

Objectives To investigate the surgical approach, feasibility and surgical outcomes of laparascopic distal gastrectomy D2 （LDGD2）. Methods Fifty-four patients who underwent LDGD2 were examined in terms of pathologic findings, operative outcomes,and complications. A simple and effective surgical procedure was as follows： gastrocolic ligament→transverse mesocolon anterior lobe→pancreatic capsule →4sb →4d →6 →qgv, 8a →12a →9 →7 → 11p, 1→3 →5 →lesser omental bursa. Efficacy and feasibility of this procedure was ana｜yzed. Results The mean operative time was （236± 51） minutes, the mean number of lymph nodes was （18±5）, the mean positive lymph nodes were 0- 14, the mean blood loss was （217±65） ml, and postoperative mean hospital stay was （15±4） days. Conclusions LDGD2 for lower and lower-middle gastric cancer is feasible and safe, and can meet the oncological demand.