脾上优先暴露在腹腔镜胃癌保脾脾门淋巴结清扫的应用

Application of splenic superior region dissection first in laparoscopic spleen-preserving splenic hilus lymphadenectomy for gastric cancer

目的:探讨脾上优先暴露法在腹腔镜进展期胃上部癌保脾脾门淋巴结清扫术中的应用。方法:回顾性分析2012年10月至2014年8月宁波市第一人民医院采用脾上优先暴露法对19例进展期胃上部癌行腹腔镜根治性全胃切除并保脾脾门淋巴结清扫术病人的临床资料和术中、术后及并发症等情况。结果:19例均成功行腹腔镜保脾脾门淋巴结清扫术。总手术时间(234±30)min,术中出血量(161±82)m L;第10组淋巴结清扫时间为(36±8)min,出血量为(33±18)m L。每例病人淋巴结清扫数(32±9)枚、第10组淋巴结清扫数(2.8±0.9)枚。2例病人有4枚第10组淋巴结转移,转移率10.5%(2/19)。病人术后肛门排气时间(3.2±1.1)d,术后进流质时间(4.0±0.8)d,术后住院时间(16.5±5.4)d,无吻合口漏、腹腔大出血及围手术期死亡。结论:脾脏上方优先暴露法临床可行,在一定程度上降低进展期胃上部癌腹腔镜保脾脾门淋巴结清扫术的手术难度,短期疗效满意。

Objective To investigate the application of splenic superior region dissection first in laparoscopic spleenpreserving splenic hilar lymphadenectomy for advanced proximal gastric cancer. Methods A total of 19 patients with advanced proximal gastric cancer underwent laparoscopie total gastrectomy with spleen-preserving splenic hilar lymphadenectomy by splenic superior region dissection first at the Ningbo First Hospital from Oct 2012 to Aug 2014. The clinical data including perioperative index and postoperative complications were retrospectively analyzed. Results All laparoscopie spleen-preserving lymphadenectomies were performed successfully. Total operation time was （234±30） min with blood loss（161±82） mL. The operation time and blood loss for No.10 lymph node dissection was （36±8） min and （33±18） mL respectively. The mean number of total lymph node dissection and No.10 lymph node dissection in 19 patients was （32±9） and （2.8±0.9） respectively. There were 4 of No.10 lymph node metastases detected in 2 cases with metastasis rate of 10.5% （2/19）. Anal exhaust time was （3.2±1.1） d and liquid diet （4.0±0.8） d later and postoperative hospital stay （16.5± 5.4） d. No major complications such as anastomotic leak, abdominal hemorrhage and no mortality were observed. Conclusions Splenic superior region dissection first is feasible in clinic and make laparoscopic spleen-preserving splenic hilus lymphadenectomy easy to some extent for advanced proximal gastric cancer with better short-time outcomes.