腹腔镜辅助根治性全胃切除术治疗进展期胃癌

目的 探讨腹腔镜辅助下D2淋巴结清扫全胃切除术(LATG)的可行性,并与开腹D2淋巴结清扫全胃切除术(OTG)比较.方法 2005年7月至2007年3月共125例进展期胃癌患者中59例行LATG,66例行OTG,记录两组的临床资料并进行分析比较.结果 59例接受LATG的患者,均无中转开腹,无手术死亡,无严重的手术并发症.与OTG组比较,LATG组手术时间延长[(330±71)min vs.(261±54)min,P=0.005],淋巴结清除数相似(36±13 us.34±16,P=0.450),术中失血量减少[(175±101)ml us.(359±210)ml,P=0.003],肠功能恢复较早(P=0.015),术后发热期缩短(P=0.024).结论 对于进展期胃癌,与D2根治性OTG相比,D2根治性LATG安全可行,并具有手术入路好、手术操作空间开阔、术中失血量少以及术后恢复快等优点.     

3D腹腔镜辅助根治性全胃切除术的临床应用

比较3D腹腔镜辅助与开腹根治性全胃切除术的临床疗效。选取2015年3月—2018年3月我院胃肠外科同一手术组收治的行3D腹腔镜辅助根治性全胃切除的胃癌患者28例(3D腔镜组)与同期行传统开腹根治性全胃切除术的患者30例(对照组),比较两组手术时间、术中出血量、淋巴节清扫数目、术后肠道恢复时间及术后出院时间情况。3D腔镜组与对照组患者手术均获成功。3D腔镜组手术时间长于对照组(P 0.05),但是3D腔镜组术中出血量、术后肠道恢复时间及术后出院时间明显少于对照组(P 0.05)。两组淋巴清扫数目无统计学差异(P0.05)。3D腹腔镜辅助较开腹根治性全胃切除术具有视野好、出血量少、创伤小、恢复快等优点,且淋巴结清扫能达到开腹手术效果;3D腹腔镜高清视野下外科医生手术操作能力和手术技巧能够更快提高,明显缩短学习曲线,值得临床应用与推广。     

腹腔镜与开腹远端胃癌根治术同期临床对比研究

目的比较腹腔镜辅助下远端胃癌根治及D2淋巴结清扫术的手术方法、可行性及安全性。方法对2004年3月至2005年5月行腹腔镜胃癌根治术44例及传统开腹手术58例病人的手术安全性、术后恢复及肿瘤根治性进行比较分析。结果腹腔镜组44例病人中43例成功完成腹腔镜手术,其中行D1+α淋巴结清扫6例,D1+β2例,D2及D2+手术35例,平均清扫淋巴结(30·11±16·97)枚,1例因胃左动脉根部淋巴结融合包绕血管而中转开腹手术。腹腔镜组手术平均用时长于开腹组[(282·84±32·81)vs(223·75±23·25)min]。腹腔镜组术中出血、切口长度、术后止痛剂注射次数以及术后肛门排气时间、下床时间分别为(139·30±82·67)mL,(5·61±0·81)cm,(1·02±1·03)次,(4·10±0·75)d,(3·24±0·777)d,显著低于开腹手术组。腹腔镜组肺部感染率低于开腹组,但差异无显著性,两组间其他并发症差异无显著性。腹腔镜组肿瘤近或(远)端切缘、淋巴结清扫数量、第一及二站淋巴结转移阳性率分别为(6·05±1·27)cm、(6·37±1·12)cm、(30·11±16·97)、47·7%及31·8%,与开腹组相比差异无显著性。术后近期随访效果良好。结论腹腔镜胃癌根治术较传统开腹手术耗时长,但能达到与开腹胃癌标准根治术(D2)相同的淋巴结清扫范围及肿瘤切缘,且具有创伤小、出血少、安全、术后恢复快等优点。     

腹腔镜辅助根治性全胃切除术106例临床分析

目的探讨腹腔镜辅助根治性全胃切除术的可行性及临床疗效。方法回顾性分析2006年3月至2010年9月行腹腔镜辅助根治性全胃切除术（腹腔镜组）106例及同期开腹根治性全胃切除术（开腹组）247例患者的临床资料。比较两组的淋巴结清扫数目及患者术中情况、术后恢复、手术并发症等指标。结果腹腔镜组清扫淋巴结数为（28.77±12.75）枚,与开腹组清扫淋巴结数（27.07±11.51）枚相比,差异无显著统计学意义（P=0.269）。腹腔镜组平均手术时间为（220.7±40.4）min,长于开腹组（178.5±29.1）min,两组差异有统计学意义（P〈0.05）。术中失血量：腹腔镜组与开腹组分别为（232.1±132.1）ml、（296.9±135.6）ml,差异有统计学意义（P〈0.05）。腹腔镜组术后肛门排气时间为（3.6±1.0）d,显著早于开腹组（4.3±0.8）d,手术并发症发生率方面,腹腔镜组与开腹组分别为17.9%、20.4%,相比差异无统计学意义（P〉0.05）。结论腹腔镜辅助根治性全胃切除术具有切口小、术后恢复快等微创优势,技术上是安全可行的,清扫淋巴结数目和开腹手术相当,符合肿瘤根治原则,近期疗效肯定。     

腹腔镜辅助根治性全胃切除术效果观察

目的探讨腹腔镜辅助根治性全胃切除术的效果。方法选取60例接受根治性全胃切除术的胃癌患者,根据手术方式不同分为2组,各30例。对照组行开腹手术,观察组实施腹腔镜手术。比较2组的治疗效果。结果观察组手术时间长于对照组,术后肛门排气时间及术中出血量均短于或少于对照组,差异具有统计学意义(P0.05)。2组淋巴结清扫数及并发症比较,差异无统计学意义(P0.05)。结论对胃癌患者实施腹腔镜辅助根治性全胃切除术,疗效显著,安全性高。     

腹腔镜与开腹胃癌根治术的临床效果对比

目的:对比腹腔镜辅助胃癌根治术与开腹胃癌根治术的临床疗效,探讨腹腔镜辅助胃癌根治术的可行性、安全性及有效性。方法:回顾分析2014年7月至2015年2月手术治疗的胃癌患者的临床资料,其中21例行开腹远端胃癌根治术;27例行腹腔镜辅助远端胃癌根治术(laparoscopically assisted distal gastrectomy,LADG);20例行开腹根治性全胃切除术;24例行腹腔镜辅助根治性全胃切除术(laparoscopically assisted total gastrectomy,LATG)。对比分析四组患者手术时间、术中出血量、术后住院时间、术后相关并发症等情况。结果:与开腹手术相比,LADG组、LATG组手术时间显著延长,但在术中出血量、胃肠功能恢复时间、术后引流管拔除时间、术后住院时间等方面具有优势。结论:腹腔镜辅助胃癌根治术安全、可靠,近期疗效肯定,具有切口小、出血少、康复快等优势,值得临床推广。     

腹腔镜辅助全胃切除术联合D2淋巴结清扫治疗中上部进展期胃癌的疗效观察

目的对比不同术式对中上部进展期胃癌(AGC)的手术效果,探讨腹腔镜辅助全胃切除术联合D2淋巴结清扫治疗中上部AGC的优势。 方法回顾性分析2012年1月至2017年1月78例中上部AGC手术患者,依据术式不同分为腹腔镜辅助组(LATG组,n＝40)及开腹组(OTG组,n＝38),应用SPSS 20.0软件进行统计学分析,术中术后指标及疼痛视觉模拟评分(VAS)等以均数±标准差的形式表示,采用独立t检验;术后并发症发生率及随访结果采用χ²检验;P<0.05差异有统计学意义。 结果与OTG组比较,LATG组的术中失血量明显较少,切口长度明显减小,术后首次排气时间、恢复流质进食时间、住院时间和术后1周、1个月疼痛视觉模拟评分(VAS)等明显较低,差异有统计学意义(P<0.05),两组手术时间、淋巴结清扫数目、术后并发症发生率及术后1年总生存率差异均无统计学意义(P>0.05)。 结论LATG联合D2淋巴结清扫术是一种安全的手术方法,在治疗中上部AGC患者上具有术中出血量少、切口短、恢复周期短,疼痛低,不增加并发症,能达到开腹手术相当的淋巴结清扫数,近期效果较为理想,值得在临床中推广。     

LATG联合D2淋巴结清扫在中上部进展期胃癌的手术效果分析

目的探讨开腹全胃切除术(OTG)联合D2淋巴结清扫术和腹腔镜全胃切除术(LATG)联合D2淋巴结清扫术在中上部进展期胃癌中的临床应用效果。 方法回顾性分析2014年1月至2017年6月88例中上部进展期胃癌资料，均行全胃切除术联合D2淋巴结清扫，按手术方式差异分为腹腔镜组(简称LATG组，37例)和开腹组(简称OTG组，51例)。采用SPSS19.0进行统计分析，两组术中术后指标、VAS评分、肿瘤标准物等用( ±s)表示，独立t检验；术后无瘤生存率、术后总生存率和术后并发症发生率，行χ²检验，P<0.05为差异有统计学意义。 结果研究结果显示LATG组手术时间、术中出血量、首次排气时间、首次进食时间、术中切口长度、术后住院时间、并发症总发生率(5.4%比21.6% )、术中相关指标、术后康复指标、术后1周、1个月的VAS评分、术后3个月的CA125、CA199、CEA水平等方面均较OTG组更优(P<0.05)。术中两组的淋巴结清扫数目差异无统计学意义(P>0.05)；截止2018年12月，术后1年无瘤生存率和总生存率比较，两组差异无统计学意义(P>0.05)。 结论LATG联合D2淋巴结清扫术是中上部进展期胃癌临床治疗的较为安全手术手术方法，具有出血量少，切口短小，术后康复快，术后疼痛感低，术后并发症较低的优势。     

腹腔镜辅助根治性全胃切除术的Meta分析

目的 从循证医学角度评价腹腔镜辅助根治性全胃切除术的安全性和有效性.方法 检索2012年2月以前公开发表的对比腹腔镜辅助根治性全胃切除术(LATG组)和开腹根治性全胃切除术(OTG组)的文献.按纳入标准筛选后进行质量评分,提取临床效应指标,采用RevMan 5.1软件对所纳入的数据进行荟萃分析.结果 本研究共纳入10个对照试验,样本总量942例,其中LATG组422例,OTG组520例.荟萃分析结果显示,与OTG组相比,LATG组手术时间长(WMD=41.12 min,95％CI:20.62 ～ 61.63,P＜0.01),术中失血量少(WMD=-198.36 ml,95％ CI:-300.94～-95.78,P＜0.01),术后肛门排气时间早(WMD=-0.80d,95％ CI:-1.17 ～-0.42,P＜0.01),总体并发症少(RR =0.55,95％ CI:0.40～0.76,P＜0.01),术后住院时间短(WMD=-4.02 d,95％ CI:-6.03 ～-2.01,P＜0.01).两组淋巴结清扫数目、切缘距离及死亡率之间相比差异均无统计学意义(P＞0.05).结论 腹腔镜辅助根治性全胃切除术安全可行,具有术中出血少、术后恢复快和并发症少等优点.     

腹腔镜辅助胃癌D2根治性全胃切除术

目的 探讨腹腔镜辅助下D2淋巴结清扫全胃切除术的手术要点.方法根据我院2005年7月至2007年4月期间61例腹腔镜辅助下D2淋巴结清扫全胃切除术患者的临床资料,对腹腔镜辅助下D2淋巴结清扫全胃切除的手术要点进行归纳分析. 结果 本组61例接受腹腔镜辅助下D2淋巴结清扫全胃切除术的患者均无中转开腹,无手术死亡,无严重的手术并发症.手术中应着重遵循以下几点:(1)避免损伤横结肠;(2)避免损伤胰头下缘;(3)先离断胃左静脉,清扫完第7、8a、9、11p组淋巴结后,最后离断胃左动脉;(4)准确无误离断胃右动脉;(5)避免清扫腹腔动脉旁淋巴结时出血;(6)避免分离脾胃韧带时出血;(7)找对间隙,分离贲门及胃底.结论了解进展期腹腔镜辅助胃癌D2淋巴结清扫全胃切除的手术要点,对顺利开展腹腔镜辅助下胃癌D2淋巴结清扫全胃切除术有益.     

全腔镜与腔镜辅助胃癌全胃切除及食管空肠吻合术疗效差异Meta分析

目的观察全腹腔镜全胃切除术(TLTG)与腹腔镜辅助全胃切除术(LATG)对胃癌根治术的疗效差异,进一步探讨全腹腔镜下食管-空肠吻合术的安全性及可行性。方法在PubMed、Web of Science、万方数据库、中国知网等中英文数据库中检索2019年9月前公开发表的关于胃癌上述两种手术方式(TLTG组与LATG组)对照研究的文献。检索关键词为胃癌、全胃切除、全腹腔镜、腹腔镜辅助、食管-空肠吻合、gastric/stomach cancer,total gastrectomy,totally/completely laparoscopic,laparoscopic-assisted/laparoscopy-assisted/laparoscopically assisted,esophagojejunostomy/esophagojejunal anastomosis。通过RevMan 5.3软件对两组的数据资料进行Meta分析。结果共检索出258篇文献,经过逐层筛选后,最终纳入11条文献,样本总量为2421例,其中TLTG组1115例,LATG组1306例。Meta结果显示,两组的年龄和性别差异无统计学意义,而TLTG组的平均BMI显著大于LATG组(P=0.01)。与LATG组相比,TLTG组的手术切口长度明显较短(P<0.001),术中出血量明显较少(P=0.003),淋巴结摘除数量明显较多(P=0.04),术后首次进食时间及术后住院时间也明显缩短(P分别为0.03和0.02),而肿瘤大小、近端切缘长度、总手术时间、吻合时间、术后疼痛评分、术后肛门排气时间、术后吻合口相关并发症(包括吻合口瘘、吻合口狭窄和吻合口出血)及术后总体并发症发生率等差异均无统计学意义(P>0.05)。结论全腹腔镜下全胃切除及食管-空肠吻合术安全可行,与LATG相比,TLTG具有创伤小、出血少、淋巴结易获取、术后恢复快等优点,且TLTG也适用于肥胖患者。     

胃癌全腹腔镜与腹腔镜辅助全胃切除术近期疗效的Meta分析

目的:对比全腹腔镜全胃切除术(TLTG)与腹腔镜辅助全胃切除术(LATG)治疗胃癌的近期疗效,评价TLTG治疗胃癌的安全性、可行性.方法:检索收集截至2020年11月发表在PubMed、MEDLINE、Embase、the Cochrane Library及Web of Science、比较TLTG与LATG治疗胃癌近...     

Laparoscopically assisted total gastrectomy with lymph node dissection for upper and middle gastric cancer

Background  In recent years, laparoscopic gastrectomy has been applied for the treatment of gastric cancer in Japan and Western countries. This report describes the short- and long-term results for patients with gastric cancer who underwent laparoscopically assisted total gastrectomy (LATG) with lymph node dissection. Methods  From September 1999 to December 2007, 20 patients underwent LATG, and 18 underwent conventional open total gastrectomy (OTG) for upper and middle gastric cancer. The indications for LATG included depth of tumor invasion limited to the mucosa or submucosa and absence of lymph node metastases in preoperative examinations. The LATG and OTG procedures for gastric cancer were compared in terms of pathologic findings, operative outcome, complications, and survival. Results  No significant difference was found between LATG and OTG in terms of operation time (254 vs 248 min.), number of lymph nodes (26 vs 35), complication rate (25% vs 17%), or 5-year cumulative survival rate (95% vs 90.9%). Differences between LATG and OTG were found with regard to blood loss (299 vs 758 g) and postoperative hospitalization (19 vs 29 days). Conclusion  For properly selected patients, laparoscopically assisted total gastrectomy can be a curative and minimally invasive treatment for early gastric cancer.     

Comparison of short- and long-term outcomes of laparoscopic-assisted total gastrectomy and open total gastrectomy in gastric cancer patients

Background

Laparoscopy-assisted total gastrectomy (LATG) has been used more frequently despite the associated technical difficulty and concerns over oncological safety. This study was undertaken to compare the short- and long-term surgical outcomes following either LATG or open total gastrectomy (OTG) for gastric cancer.

Methods

A total of 120 LATG and 228 OTG were retrospectively matched with respect to sex, age (±5 years), and pathological tumor-node-metastasis stage for comparison of the clinical outcomes.

Results

The total complication rate among 120 LATG and 228 OTG was 18.3 % (22/120) and 16.2 % (37/228), respectively. The most common complication after LATG was anastomotic-related complication (6.7 %); five anastomotic leakages (4.2 %) and three anastomotic strictures were reported (2.5 %). That after OTG was wound complication (3.5 %), including seroma or infection. Matched patients analysis: Time to first gas passing and time to the resumption of a soft diet were significantly shorter in the LATG group than in the OTG group. The postoperative hospital stay of LATG was shorter in the LATG group (9.3 ± 4.2 days) than in the OTG group (11.7 ± 7.3 days; p = 0.057). Among matched patients, there was no significant difference between complication rate (24 vs. 32 %; p = 0.504) or leakage rate (6 vs. 4 %). During median follow-up of 50 (range, 10–92) months, there was no significant difference in the disease-free survival rate between the matched groups, respectively (94.5 vs. 87.1 %: p = 0.148). As for patients with TNM stage I gastric cancer, the disease-free survival rate (100 vs. 90.9 %; p = 0.5) and the cumulative survival rate (91.5 vs. 95.2 %; p = 0.618) did not differ significantly between the LATG and OTG groups.

Conclusions

LATG for gastric cancer has the advantage over an OTG in terms of better short-term outcomes and similar long-term outcome. LATG is an acceptable alternative to OTG for the treatment of gastric cancer.     

Laparoscopy-assisted pancreas- and spleen-preserving total gastrectomy for gastric cancer as compared with open total gastrectomy

Background

Laparoscopy-assisted total gastrectomy (LATG) is not widely used for the treatment of gastric cancer located in the upper or middle third of the stomach. To assess the safety and usefulness of LATG, we compared the outcomes of LATG with those of open total gastrectomy (OTG).

Methods

From July 2004 to July 2007, we performed pancreas- and spleen-preserving total gastrectomy with D1 + β or D2 lymph-node dissection and Roux-en-Y reconstruction in 74 patients with cancer located in the upper or middle third of the stomach. Of these patients, 30 underwent LATG (LATG group) and 44 underwent OTG (OTG group). Short-term outcomes were compared between the groups.

Results

Operation time was significantly longer in the LATG group than in the OTG group (313 min vs. 218 min, p < 0.001). Blood loss (134 g vs. 407 g, p < 0.001) and the rate of the use of analgesics (6.8 times vs. 11.8 times, p < 0.05) were significantly lower, and postoperative hospital stay was significantly shorter in the LATG group than in the OTG group (13.5 days vs. 18.2 days, p < 0.05). The LATG group had better hematologic and serum chemical profiles, including white-cell counts, C-reactive protein levels, total protein levels, and albumin levels, as well as lower rate of postoperative body-weight loss. The number of dissected lymph nodes (43.2 vs. 51.2, p = 0.098) and the rate of postoperative complications (20.0% vs. 27.3%, p = 0.287) were similar in the groups. However, major complications such as anastomotic leakage, abdominal abscess, and pancreatic leakage occurred in six patients (13.6%) in the OTG group, but in none of the patients in the LATG group.

Conclusions

LATG is associated with less severe complications and better postoperative quality of life than OTG. We believe that LATG is a safe, useful, and less invasive alternative for the treatment of gastric cancer located in the upper or middle third of the stomach.     

腹腔镜与开腹胃癌根治术临床疗效比较及术后随访

目的 对比研究腹腔镜辅助与开腹胃癌全胃切除术的临床效果.方法 回顾性分析42例行腹腔镜胃癌全胃切除术患者的临床资料及术后生存情况,同期62例行开腹全胃切除治疗的患者作对照.结果 腹腔镜组切口长度（6.5±1.7）cm、平均失血量（228±29） ml、术后肛门排气时间（2.4±0.7）d、首次进流食时间（4.9±0.6）d.对照组切口长度（15.4±2.5）cm、平均失血量（260±34）ml、术后肛门排气时间（3.2±1.0）d、术后首次进流流食时间（5.4±0.5）d,两组相比差异有统计学意义（P＜0.05）;腹腔镜组手术时间[（248±47）min]显著高于开腹组（205±40）min,差异有统计学意义（P＜0.05）;腹腔镜组术后住院时间[（9.4±3.7）d]、淋巴结清扫数目[（25.1±2.7）个]与开腹组[（11.2±5.3）d、（26.0±3.4）个]相比,差异无统计学意义（P＞0.05）;腹腔镜组与开腹组术后并发症发生率分别为14.3%与19.4%;术后随访3年内生存率差异无统计学意义（P＞0.05）.结论 在不影响远期效果的情况下,腹腔镜辅助全胃切除术具有术中出血量小、手术切口小、术后肛门排气时间短、术后进流食时间短等优点.     

Laparoscopically assisted total gastrectomy with jejunal pouch interposition

Background Jejunal pouch interposition (JPI) is known as a useful gastric replacement procedure after total gastrectomy. The JPI procedure, however, has not been applicable to laparoscopically assisted total gastrectomy (LATG) because of its technical complexity and difficulty. This study aimed to describe our modified LATG/JPI technique, and to evaluate its feasibility, safety, and early postoperative functional outcome. Methods Between September 2002 and August 2003, LATG/JPI was attempted for five patients (3 men and 2 women) with early gastric cancers in the upper portion of the stomach. The mean age of the patients was 57 years, and their BMI was 21 kg/m². Using a 5-port technique, the gastric arteries were laparoscopically clipped and divided with adequate lymphatic dissection. After completion of gastric resection, the anvil of a circular stapling device was placed in the esophageal stump. An 8-cm minilaparotomy then was performed, and the 12-cm pouch was created extracorporeally in the “reverse U” fashion. The stapled pouch-esophagostomy was performed under laparoscopic monitoring. The remainder of the procedure was accomplished under direct vision. Results All cases were managed laparoscopically without any complications. The mean operating time was 407 min, and the blood loss was 279 ml. All the patients showed rapid and uneventful recovery. Postoperative studies, including dual scintigraphy, showed that all jejunal pouches were satisfactorily functioning. Conclusions This study showed LATG/JPI to be feasible and safe. With technical modifications, LATG/JPI can become a potentially effective option for improving patients’ quality of life after total gastrectomy.     

Laparoscopically assisted total gastrectomy with sentinel node biopsy for early gastric cancer: preliminary results

This study sought to describe a procedure involving laparoscopically assisted total gastrectomy (LATG) with sentinel node biopsy (SNB) and to evaluate the results of the first three patients. LATG for early gastric cancer was performed with sentinel node (SN) identification using a combined patent blue-violet dye and 99mtechnetium-labeled tin colloid technique. Laparoscopically resected SNs were processed for frozen section examination by routine hematoxylin and eosin (H&E) and immunohistochemical cytokeratin (IHC-CK) stains. LATG consists of a four-surgical port technique, removal of the specimen through a small 5-cm laparotomy, and stapled Roux-en-Y esophagojejunostomy. Five patients were candidates for LATG with SNB between March 2001 and June 2003; two had open surgery because of a tumor extending the serosal surface and peritoneal dissemination, whereas in the remaining three, SNs were successfully identified and evaluated with no evidence of sentinel node (micro) metastases intraoperatively. Based on the results of SNB, three patients underwent LATG with adequate lymphadenectomy. Mean operative time and blood loss were 375 min and 219 mL, respectively. No dissected lymph nodes had evidence of metastasis by H&E and IHC-CK on permanent sections. LATG with SNB followed by adequate lymphadenectomy is technically feasible, and with its acceptable operative time and blood loss, presents an excellent therapeutic option for early gastric cancer; while SNB and subsequent frozen section analysis by H&E and IHC-CK staining is a rapid and reliable diagnostic method for intraoperative detection of SN (micro) metastasis. This combination treatment is a promising alternative to laparoscopic gastrectomy with conventional lymphadenectomy.     

腹腔镜胃癌全胃切除术

目的 探讨腹腔镜下胃癌全胃切除术的可行性、方法和效果.方法 回顾性分析行腹腔镜下全胃切除术的63例胃癌患者的f临床资料,探讨手术方法,观察术后疗效.结果 腹腔镜下根治性全胃切除52例,姑息性全胃切除5例.前期45例在小切H直视下行食管空肠吻合,后期12例在腹腔镜下行食管空肠吻合.中转开腹6例.手术用时(312±35)min,术中出血量(190±50)ml,清扫淋巴结(32±7)枚,术后患者胃肠功能恢复时间(4.0 ±1.2)d,进食时间(4.5±1.5)d,下床活动时间(4.0±1.5)d.5例出现手术相关并发症,术后近期效果良好.结论 腹腔镜胃癌全胃切除术安全可行,创伤小,术后恢复快,能够达到与开腹手术相当的根治范围.