“Ω＂形动脉游离路径在腹腔镜胃癌根治术中胰腺上区淋巴结清扫中应用研究

The application of "Ω"-shaped arterial dissociating path in the upper pancreatic region dissection of laparoscopic radical gastrectomy

目的探讨"Ω"形动脉游离路径在腹腔镜胃癌根治术胰腺上区淋巴结清扫中的应用。方法回顾性分析吉林大学第一医院外科2017年4月至2017年10月间收治的连续72例接受腹腔镜D2根治术的胃中下部癌病人资料,均采用"Ω"形动脉游离路径进行胰腺上区的淋巴结清扫,记录病人的手术时间、术中出血量、收获淋巴结数量、术后肠蠕动恢复时间、术后排气时间、术后并发症等。结果通过"Ω"形动脉游离路径进行胰腺上区的淋巴结清扫实现了No.8、No.9、No.11p、No.12a淋巴结的确切清扫,胰腺上区淋巴结清扫完成所需时间为(41.4±11.3)min,平均术中出血量(56.0±9.2)mL,术中通过"Ω"形动脉游离路径,实现了脾动脉近270?的裸露,门静脉和脾静脉显露良好,无术中副损伤出现。结论在胰腺上缘通过"Ω"形血管游离路径,可实现静脉头侧端为边界的胰后筋膜和Toldt筋膜突破,有利于获得淋巴结的完整切除。

Objective To illustrate the application of ＂Ω＂-shaped arterial dissection in the upper pancreas dissection of radical gastrectomy based on the local anatomical understanding of the ＂membrane and stratum＂ of the stomach. Methods 72 gastric cancer patients undergoing D2 radical resection in our department from April 2017 to October 2017 were treated with an＂l）＂-shaped arterial dissociating path to perform lymph node dissection in the upper pancreas. Operative time, intraoperative blood loss, number of harvested lymph nodes, postoperative recovery time of bowel movements, postoperative venting time, postoperative complications, and other clinical data were recorded. Results The ＂Ω ＂-shaped arterial dissociating pathway achieved radical lymph node dissection in the upper pancreas.The duration of dissection of the upper pancreas was （41.4_＋ 11.3）min, and the mean intraoperative blood loss was （56_＋ 9.2） mL.The ＂Ω＂-shaped arterial dissociating path achieved almost 270Ω exposure of the splenic artery.The portal vein and splenic vein were well exposed.No intraoperative injury occurred. Conclusion Through the ＂Ω ＂-shaped vascular dissociating path in the upper edge of the pancreas, a breakthrough of the posterior pancreatic fascia and Toldt＇s fascia at the lateral end of the venous can be achieved to achieve complete resection of the lymph nodes.