腹腔镜胃癌根治术需关注的几个问题

Problems needing attention in laparoscopic radical gastrectomy for gastric cancer

微创性、安全性和肿瘤的根治性是腹腔镜胃癌手术的三大基本原则,以循证医学为基础不断更新、发展和完善。本文将现有的指南、共识及文献报道与自身经验相结合,对手术适应证的选择、不同手术入路的优劣、淋巴结清扫的顺序和质量控制以及全腹腔镜下消化道重建不同方式的特点进行探讨。在国内外广泛开展腹腔镜手术治疗早期和局部进展期胃癌的背景下,如何合理、规范的开展手术,是值得外科医生关注的问题,手术理念的进步和手术技术的发展也必将让更多的患者受益。

Laparoscopic radical gastrectomy(LRG)is constantly updating,developing and improving on the basis of evidence-based medicine,the three basic principles of which are minimally invasive,surgical safety and radical resection of tumor.Combining the guidelines,consensus and published studies with our own experiences,this paper discusses the indications of surgery,the advantages and disadvantages of different surgical approaches,the sequence and quality control of lymphadenectomy,and the characteristics of different total laparoscopic reconstruction of digestive tract.Under the popularity of LRGfor early and local advanced gastric cancer at home and abroad,reasonable and standardLRGis a noteworthyproblem for the surgeons.The progress of surgical concept and the development of surgical technology will benefit more patients with gastric cancer.