腹腔镜全胃切除术淋巴结清扫范围与策略

Scope and strategy of lymph node dissection by laparoscopic total gastrectomy

随着精准诊疗和微创理念的发展,胃癌的治疗策略逐渐多样化、精细化,但对于进展期胃癌患者,根治性的手术切除仍是其治疗过程中的关键。随着腹腔镜技术的推广应用,腹腔镜全胃切除术在全国三级医院均广泛开展,所以只有形成一套详细完整的胃癌手术淋巴结清扫策略,才能成为各医院开展腹腔镜胃癌手术的质量保障。腹腔镜全胃切除术需要在胃周进行多层次、多间隙的分离与解剖,要精准的裸化离断胃周血管,并彻底地清扫胃周淋巴结,才能保障手术的根治性。通常将胃周淋巴结的清扫分为幽门下区域、胰腺上区域、幽门上区域、脾门区域和贲门区域等五个区域。清扫各个区域的过程中需要术者、助手和扶镜手默契配合,才能保障腹腔镜全胃切除术淋巴结清扫的顺利进行。

With the development of precision diagnosis and treatment and minimally invasive concepts,the treatment strategies for gastric cancer have gradually diversified and refined,but for patients with advanced gastric cancer,radical surgical resection is still the key process in the treatment.With the promotion and application of laparoscopic technology,laparoscopic total gastrectomy has been widely carried out in tertiary hospitals across China.Therefore,only a detailed and complete set of surgical lymph node dissection strategies for gastric cancer can be developed to guarantee the quality of laparoscopic gastric cancer surgery in hospitals of all levels.Laparoscopic total gastrectomy requires multi-level and multi-space separation and dissection around the stomach,accurate naked dissection of perigastric blood vessels,and thorough dissection of perigastric lymph nodes,in order to ensure the radical operation.The dissection of perigastric lymph nodes is usually divided into five regions:subpyloric region,suprapancreatic region,suprapyloric region,splenic hilum region and cardiac region.In the process of cleaning each area,the tacit cooperation of the surgeon,the assistant and the mirror holder is required to ensure the smooth progress of laparoscopic total gastrectomy lymph node dissection.