胃上部癌根治术中脾门淋巴结清扫的现状与争议

The current status and controversy of splenic hilar lymph node dissection for proximal gastric cancer with radical gastrectomy

淋巴结清扫是胃癌手术达到D2根治的关键,更与患者的预后息息相关。从开腹联合脾切除到腹腔镜下保留脾脏的脾门淋巴结清扫,No.10组淋巴结清扫始终是进展期胃上部癌根治术的难点所在。虽然有研究证实胃上部癌根治术清扫脾门淋巴结可取得好的短期疗效但目前仍缺乏高级别的循证医学证据,而且脾门区域淋巴结解剖复杂,盲目的清扫,常易造成不必要的损伤,甚至导致严重的并发症。胃上部癌根治术中脾门淋巴结清扫不同学者对手术安全性、手术入路、是否联合脾切除、脾血管后方淋巴结是否常规清扫,仍有较多争议。本文将从脾门淋巴结清扫的现状、腹腔镜下不同手术入路、脾门淋巴结清扫的争议等方面综述目前对胃上部癌根治术中脾门淋巴结的研究情况。

Lymphadenectomy is critical for radical gastrectomy with D2 lymph node dissection,which is especially correlated with the prognosis of patients.From laparotomy total gastrectomy combined with splenectomy to laparoscopic spleen-preserving splenic hilar lymph node dissection,the difficulty of radical gastrectomy for the advanced proximal gastric cancer is station 10 lymph node dissection all the time.Although researches have confirmed that dissection of splenic hilar lymph node for proximal gastric cancer could showed good curative effect in the short term,which is lack of support of Evidence-Based Medicine,cleaning the splenic hilar lymph node without rigorously plan could cause more damage to the patients,even irreversible complications owing to the anatomical complexity.For splenic hilar lymphadenectomy of radical gastrectomy for the advanced proximal gastric cancer,some scholars hold dissenting opinion about surgical safety,surgical approach,total gastrectomy splenectomy,the routine splenic vessel posterior lymph nodes dissection,etc.In this paper,we will review the current status of splenic hilar lymph node for radical gastrectomy for the advanced proximal gastric cancer,and the controversy of splenic hilar lymphadenectomy,different laparoscopic surgical approach and so on.