“胰腺中心解剖法”在62例腹腔镜胃癌淋巴结清扫术中的应用

Application of pancreas-centered anatomy to lymphadenectomy in laparoscopic gastrectomy in 62 cases

目的:分析“胰腺中心解剖法”在腹腔镜胃癌淋巴结清扫术中的疗效和安全性。方法:回顾性分析弋矶山医院2016年1月~2018年12月共收治胃癌患者62例,男性35例,女性27例,胃窦癌42例,胃体癌20例。患者年龄42~73岁,平均(62.40±11.25)岁,胃窦癌行腹腔镜远端胃癌根治术,胃体癌行腹腔镜全胃根治切除术,采用“胰腺中心解剖法”进行腹腔淋巴结清扫。记录分析手术时间、术中出血量、手术时间等。结果:62例患者均顺利完成手术,无中转开腹手术,手术时间160~270(217.36±51.45)min,术中出血量100~200(135.24±32.48)mL,清扫淋巴结个数16~28(21.76±5.48)枚,住院时间8~13(10.25±1.73)d,术后胃肠道功能恢复时间28~66(52.46±14.37)d。均顺利出院。无围手术期死亡及严重并发症发生,无非计划再次手术。术后随访6~12月,肿瘤患者无局部复发及远处转移。结论:以胰腺为中心的胃周淋巴结清扫手术是安全、可行的。

Objective:To assess the therapeutic effect and safety of pancreas-centered anatomy in lymphadenectomy in patients undergoing laparoscopic gastrectomy.Methods:Clinical data were respectively analyzed in 62 cases of gastric cancer undergone laparoscopic gastrectomy in our hospital between January 2013 and December 2018.Of the 62 patients,35 were males and 27 females.The cancer was found at the antrum in 42 and corpus of the body in 20.The patients aged from 42 to 73 years old,with an average of(58.6±13.2)years.Gastric cancer in the antrum was treated by distal laparoscopic gastrectomy,and the neoplasm in the gastric corpus was managed by total laparoscopic gastrectomy.Pancreas-centered anatomy was applied to radical lymphadenectomy.Operative time and intraoperative blood loss were maintained in all patients.Results:The surgery was successfully completed in the 62 patients,without conversion to open operation surgery.The operative time ranged from 160 to 270 min[mean:(217.36±51.45)min],and intraoperative bleeding volume was from 100 to 200 mL[mean:(135.24±32.48)mL].Averagely,21.76±5.48 lymph nodes(ranging from 16 to 28)were dissected.The hospital stay and postoperative recovery of gastrointestinal function ranged from 8 to 13 days[mean:(10.25±1.73)d]and from 28 to 66 h[mean:(52.46±14.37)h],respectively.All patients were discharged safely.No severe complications and perioperative death occurred,and no unplanned reoperation was required.Postoperative follow-up between 6 and 12 months showed that no local recurrence or distal metastasis occurred.Conclusion:Pancreas-centered anatomy can be possibly and safely applied to lymphadenectomy in patients undergoing laparoscopic gastrectomy.