摘要
目的:探讨腹腔镜下“四步法”脾门淋巴结清扫术治疗进展期近端胃癌的安全性与可行性。方法:回顾分析2022年1月至2023年1月收治的35例进展期近端胃癌患者的临床资料,均行腹腔镜下根治性全胃切除术联合“四步法”保留脾脏的脾门淋巴结清扫术,分析患者术中、术后及并发症情况,术后通过电话及门诊方式进行随访,随访截至2024年1月。结果:35例患者均顺利完成脾门淋巴结清扫,手术时间平均(257±19)min;术中出血量平均(61±38)mL;No.10、11d淋巴结清扫时间平均(40±5)min,平均出血量(35±26)mL;35例患者淋巴结清扫总数为1357枚,平均清扫淋巴结(39±5)枚;No.10、N o.11d淋巴结清扫总数为90枚与57枚,淋巴结转移率分别为11.11%(10/90)与14.04%(8/57),No.10、No.11d淋巴结清扫数量平均(2.6±1.6)枚与(1.6±0.9)枚,转移率分别为25.71%(9/35)与22.86%(8/35)。术后首次排气时间(3.3±0.6)d,术后进流质饮食时间(4.3±0.7)d,术后平均住院(12±4)d。术后均未发生吻合口漏,Clavien-DindoⅠ级、Ⅱ级并发症发生率为17.14%(6/35)。术后根据病理结果予以规范化疗,35例患者均获得随访,随访期间无死亡,未发现肿瘤复发或转移。结论:腹腔镜全胃切除术中应用“四步法”脾门淋巴结清扫治疗进展期近端胃癌安全、可靠。
Objective:To investigate the safety and feasibility of laparoscopic"four-step method"splenic hilar lymph node dissection in advanced proximal gastric cancer.Methods:A retrospective analysis was conducted on the clinical data of 35 patients with advanced proximal gastric cancer treated from Jan.2022 to Jan.2023.All patients underwent laparoscopic radical total gastrectomy with spleen-preserving splenic hilar lymph node dissection using the"four-step"method.The intraoperative,postoperative,and complication-related outcomes were analyzed in the patients.Postoperative follow-up was conducted via telephone and outpatient visits.The follow-up period ending was Jan.2024.Results:All patients successfully underwent splenic hilar lymph node dissection,and the mean operative time was(257±19)min,the average intraoperative blood loss was(61±38)mL;the dissection time for No.10 and No.11d lymph nodes was(40±5)min,and the average blood loss was(35±26)mL.A total of 1357 lymph nodes were dissected in 35 patients,the a verage number of lymph nodes dissected was(39±5),the total number of No.10 and No.11d lymph nodes dissected were 90 and 57,respectively,and the No.10 and No.11d lymph node metastatic rates were 11.11%(10/90)and 14.04%(8/57),respectively.The average number of No.10 and No.11d lymph nodes dissected were(2.6±1.6)and(1.6±0.9),respectively,and metastatic rates were 25.71%(9/35)and 22.86%(8/35),respectively.The time to first flatus postoperatively was(3.3±0.6)d,the time to start consuming liquid food was(4.3±0.7)d,and the average hospital stay was(12±4)d.No anastomotic leakage occurred postoperatively,and the Clavien-Dindo gradeⅠandⅡcomplication rate was 17.14%(6/35).Postoperatively,all patients received standardized chemotherapy based on pathological results,and all patients were followed up,with no deaths,tumor recurrence,or metastasis observed during the follow-up.Conclusions:The laparoscopic"four-step method"for splenic hilar lymph node dissection in total gastrectomy for the treatment of advanced proximal gastric cancer is safe and dependable.
作者
姚富强
杨成城
李帅鹏
范青文
吴超飞
杨展鹏
吴刚
张超
YAO Fuqiang;YANG Chengcheng;LI Shuaipeng(Department of Gastrointestinal Surgery,Zhengzhou University People's Hospital,Henan Provincial People's Hospital,Zhengzhou 450003,China)
出处
《腹腔镜外科杂志》
2025年第1期23-27,共5页
Journal of Laparoscopic Surgery
关键词
胃肿瘤
全胃切除术
腹腔镜检查
脾门
淋巴结切除术
Stomach neoplasms
Total gastrectomy
Laparoscopy
Hilum of spleen
Lymph node excision
