腹腔镜胃癌根治术淋巴结清扫手术入路的合理选择

腹腔镜技术在胃癌根治术中的应用已有较长时间，但是由于胃的解剖层面复杂、血供丰富、腹腔镜手术器械操作等特殊性，使腹腔镜胃癌淋巴结清扫的难度较大，技术要求较高。合理的手术入路是腹腔镜胃癌淋巴结清扫术成功的开始，也是手术顺利进行的前提。术者在熟知胃癌淋巴结引流及解剖特点的基础上，根据患者的体位、术者的站位、淋巴结清扫顺序等，不同的区域，如幽门下区、胰腺上缘区和脾门区中选择不同的手术入路，以保证安全、彻底的胃周淋巴结清扫。本文介绍本课题组在腹腔镜胃癌根治术中不同区域淋巴结清扫时的手术入路选择，以期为开展腹腔镜胃癌手术的外科医师提供参考。 

Appropriate approach for laparoscopic lymph node dissection of advanced gastric cancer

Since its first application for radical gastrectomy, laparoscopic surgical technique has been used for almost 20 years. Howev-er, given the complexity of the anatomic plane and vessels of stomach and the particular operation of laparoscopic instruments, lapa-roscopic lymph node dissection is still a difficult technique that requires experience. An appropriate approach is the key point to the success of laparoscopic lymph node dissection. On the basis of lymphatic drainage routes and anatomy of perigastric lymphatic sys-tem, different approaches are selected to dissect periodic gastric lymph nodes safely and radically. Surgery is performed according to the patient's position, surgeons' stance, and sequence of lymphadenectomy for laparoscopic gastrectomy and lymph node areas, such as suprapancreatic, cardial, and splenic hilar areas. In this article, we introduce different surgical approaches of laparoscopic radical gastrectomy with extended lymphadenectomy to provide information for surgeons who want to perform this surgery.