局部进展期胃上部癌腹腔镜淋巴结清扫的评价与策略

Evaluation and strategy of laparoscopic lymph node dissection for locally advanced upper gastric cancer

自1991年日本Kitano等率先开展腹腔镜早期胃癌根治术以来，腹腔镜胃癌手术适应证逐步扩大，由早期胃癌拓展到较早的进展期胃癌，淋巴结清扫范同亦由D1、D1＋逐步发展到D2，1997年Goh等首次将腹腔镜胃癌D2手术用于治疗进展期胃癌、近年来．越来越多的研究显示，局部进展期远端胃癌行腹腔镜辅助远端胃大部切除及D2淋巴结清扫安全可行，而且能达到与肝腹手术相当的临床肿瘤学疗效”。

The scope of laparoscopic lymph node dissection tor locally advanced upper gastric cancer （LAUGC） must be the same as its open surgery. Generally speaking, the dissection with laparoseopic surgery, including splenic hilar lymph node dissection as its important part, is quite ctiffieult. At present, this operation is still in the exploratory stage. Evidence shows thai its short-term effect is satisfying, but the long-term outcome is still controversial. Strict indications, skilled ]aparoseopic operation techniques, stable surgical team and pro- cedural operation pt＇ocess are the basic guarantee for the success of laparoseopic surgery.