进展期近端胃癌保脾根治手术进展

Surigcal Progress of Spleen-preserving Radical Gastrectomy for Advanced Proximal Gastric Cancer

按照第14版《日本胃癌处理规约》规定,近端胃癌根治D2淋巴结清扫术必须清扫脾门淋巴结。胰尾与脾门之间解剖复杂,彻底清扫脾门淋巴结存在技术上困难,为达到彻底清扫的目的,联合脾切除曾为近端胃癌D2根治术的常规术式。研究人员近年来对脾脏功能进行深入研究发现脾脏具有重要的免疫功能,保留脾脏对患者预后具有重要意义。随着外科医生手术技术的提高,进展期近端胃癌保脾根治手术逐渐开展。本文就进展期近端胃癌保脾根治手术的可行性、保脾适应证、手术相关解剖及入路等方面进行综述。

According to the guideline of 14th edition of“Japan Gastric Cancer Treatment Protocol”, the D2 Lymphadenectomy during the radical gastrectomy of proximal gastric cancer required the dissection of the splenic hilar lymph node .However , the anatomy between the pancreatic tail and splenic hilar was so complex, and it is difficult to dissect completely .In order to achieve the complete dissection , the combined splenectomy was once the normal operation of D 2 Lymphadenectomy for the advanced proximal gastric cancer.In recent years , the researchers have made the in-depth studies on the spleen function , and found it with important immunologic function , and preserving the spleen is of great significance for the patient ’ s prognosis.With the improvement of the surgical skills , the spleen-preserving radical gastrectomy for advanced proximal gastric cancer has been gradually developed .This paper has summarized the feasibility , indications , and associated anatomy and approach in the spleen-preserving radical gastrectomy for advanced proximal gastric cancer .