腹腔镜进展期胃上部癌保脾脾门淋巴结清扫术36例体会

The experience of laparoscopic spleen-preserving splenic hilar lymph node dissection in the treatment of 36 cases of advanced proximal gastric cancer

目的：探讨腹腔镜保脾脾门淋巴结清扫术在局部进展期胃上部癌根治术中的安全性及疗效。方法：回顾分析2013年3月至2014年7月36例局部进展期胃上部癌患者行腹腔镜保脾脾门淋巴结清扫术的临床资料。结果：36例手术均获成功,无一例中转开腹。脾门淋巴结清扫时间平均（43.1±9.6）min,术中出血量平均（42±11）ml,脾门淋巴结清扫数量平均（3.1±1.6）枚,平均住院（12.0±3.4）d。1例患者术后发生左侧胸腔积液,经治疗康复出院,余者均未出现脾门区出血、脾缺血或坏死、胰漏等手术相关并发症。术后随访1～16个月,随访方式为术后复查及电话随访,未发现远处转移及术后死亡病例。结论：腹腔镜局部进展期胃上部癌保脾脾门淋巴结清扫术安全、可行,且能达到与开放手术相同的淋巴结清扫效果。

Objective： To investigate the efficacy and safety of laparoscopic spleen-preserving splenic hilar lymph node dissection in the treatment of locally advanced proximal gastric cancer. Methods： Retrospective analysis was made on the clinical data of 36 patients who suffered from locally advanced proximal gastric cancer and underwent laparoscopic spleen-preserving splenic hilar lymph node dissection from Mar. 2013 to Jul. 2014. Results： All the 36 cases of operation were successful,and no case was converted to open operation. The average operation time for dissection of splenic hilar lymph node was（ 43. 1 ± 9. 6） min,the intraoperative hemorrhage was（ 42 ± 11） ml,the average number of harvested splenic hilar lymph node was（ 3. 1 ± 1. 6）,the mean hospital stay was（ 12. 0 ±3. 4） d. The left pleural effusion occurred in 1 patient who was cured and discharged,the others did not suffered from hemorrhage at the splenic hilus,spleen ischemia or necrosis,pancreatic leakage or other operation related complications. Patients were followed up for 1-16 months,follow-up method was postoperative re-examination and telephone follow-up,no distant metastasis and no postoperative death was found. Conclusions： Laparoscopic spleen-preserving splenic hilar lymph node dissection resection is safe and feasible for locally advanced proximal gastric cancer,and can achieve the same radical effect of lymph node dissection as open operation.