膜解剖理论指导下的腹腔镜胃癌根治术中经横结肠入路胃网膜左系膜的游离及解剖学观察

Disassociation and anatomical observation of gastroepiploic left mesentery via transverse colon approach in laparoscopic radical gastrectomy under the guidance of membrane anatomy theory

目的:观察膜解剖理论指导下的腹腔镜胃癌根治术中胃网膜左系膜的解剖学特点,并探讨经横结肠入路胃网膜左系膜游离的临床价值。方法:回顾分析2022年1月至2024年2月在膜解剖理论指导下行腹腔镜胃癌根治术的42例患者的临床资料。记录胃网膜左系膜游离时间、术中出血量、清扫淋巴结数量、术后相关并发症、术后恢复情况等。结果:42例手术均获成功,胃网膜左系膜表面由完整的膜组织包裹,以胃网膜左血管起始处为系膜根部,系膜体部倒卧在由结肠脾曲及系膜、脾下极肾前筋膜、胰尾部胰腺固有筋膜组成的系膜床上,呈现千姿百态的三维结构。胃网膜左系膜游离时间20~33 min,平均(24±3.2)min;出血量2~15 mL,平均(6.5±1.3)mL;淋巴结清扫数量4~8枚,平均(5.6±2.1)枚。术后发生吻合口狭窄、吻合口出血、反流性食管炎、切口感染、肺部感染各1例,均经保守治疗治愈,无手术死亡病例。结论:膜解剖理论指导下的腹腔镜胃癌根治术中均可观察到胃网膜左系膜。经横结肠入路胃网膜左系膜的游离策略是可行、可重复的,具有一定的应用价值。

Objective:To observe the anatomical characteristics of the left gastroepiploic mesentery in laparoscopic radical gastrectomy for gastric cancer under the guidance of the membranous anatomy theory,and to explore the value of the left gastroepiploic mesentery dissociation through the transverse colon approach.Methods:The clinical data of 42 patients who underwent laparoscopic radical gastrectomy under the guidance of membrane anatomy theory from Jan.2022 to Feb.2024 were retrospectively analyzed.The time of left gastroepiploic mesentery dissociation,intraoperative blood loss,the number of cleared lymph nodes,postoperative related complications,and postoperative recovery were recorded.Results:All 42 operations were successful.The surface of the left gastroepiploic mesentery was encapsulated by intact membranous tissue,with the root of the mesentery at the origin of the left gastroepiploic vessel,and the body of the mesentery lying upside down on the bed of the mesentery consisting of the colonic splenic flexure and the mesentery,the anterior renal fascia of the lower pole of the spleen,and the fascia propria of the pancreas at the caudal portion of the pancreas,which showed multifarious three-dimensional structures.The time of left gastroepiploic mesentery dissection was 20~33 min,with an average of(24±3.2)min,the amount of bleeding was 2~15 mL,with an average of(6.5±1.3)mL,and the number of lymph nodes dissected was 4~8,with an average of(5.6±2.1).Postoperative anastomotic stenosis,anastomotic bleeding,reflux esophagitis,incision infection and pulmonary infection occurred in 1 case respectively,all were cured by conservative treatment,and there was no surgical death.Conclusions:The left gastroepiploic mesentery could be observed in laparoscopic radical gastrectomy for gastric cancer under the guidance of membranous anatomy theory.The strategy of left gastroepiploic mesentery dissociation via transverse colon approach is feasible and r eproducible,and has application value.