改良手辅助腹腔镜全胃切除的脾门淋巴结清扫

Splenic hilar lymph node dissection in modified hand-assisted laparoscopic radical total gastrectomy

目的:探讨改良手辅助腹腔镜根治性全胃切除术中脾门淋巴结清扫的安全性及可行性。方法:回顾性分析2012年6月—2013年7月8例胃癌患者采用改良手辅助腹腔镜全胃切除+脾门淋巴结清扫患者的临床资料。结果:8例患者手术均成功实施,无中转开腹者,无因术中损伤脾血管或脾实质而行脾切除术者。8例患者共清扫脾门淋巴结27枚,阳性淋巴结3枚(11.1%);脾门淋巴结清扫时间平均为23 min,患者术中平均出血量为176 mL,平均住院时间为9.5 d;术后出现肺部感染1例,术后平均累计随访时间为3.6个月,无肿瘤复发及死亡病例,患者精神状态均良好。结论:运用改良手辅助腹腔镜技术清扫脾门淋巴结安全可行,远期疗效有待进一步研究。

Objective： To evaluate the safety and feasibility of splenic hilar lymph node dissection during modified hand- assisted laparoscopic radical total gastrectomy. Methods： The clinical data of 8 gastric cancer patients undergoing modified hand-assisted laparoscopic radical total gastrectomy and splenic hilar lymph node dissection from June 2012 to July 2013 were retrospectively analyzed. Results： Procedures were successfully completed in all the 8 patients without open conversion, and none of them underwent splenectomy for intraoperative splenic vascular or parenchymal injury. A total of 27 lymph nodes were dissected from the 8 patients, and 3 （11.1%） of the lymph nodes were found positive for cancer. The average time for splenic hilar lymph node dissection was 23 min, average intraoperative blood loss was 176 mL, and average length of postoperative hospital stay was 9.5 d. One patient developed pulmonary infection after operation. Theaverage cumulative follow-up for all patients was 3.6 months, during which time, no tumor recurrence or death occurred, and the general condition of all of the patients was satisfactory. Conclusion： Splenic hilar lymph node dissection during modified hand-assisted laparoscopic radical total gastrectomy is safe and feasible; however, its long-term effectiveness must be further assessed.