试析腹腔镜胃癌根治术淋巴结清扫的相关问题

手术是胃癌治疗的基石，但关于淋巴结清扫的范围东西方学者一度有过争论。基于2010年Dunch研究15年随访结果，D2淋巴结清扫作为进展期胃癌治疗的标准术式方得到普遍认同。至此也为胃癌腹腔镜淋巴结清扫术的应用奠定基础，开启了胃癌外科治疗的新纪元。自从1994年日本Kitano教授进行了首例腹腔镜手术治疗早期胃癌以来，其应用于胃癌的证据越来越多，现已被日本胃癌治疗指南推荐为早期远端胃癌的标准治疗选择。在我国，依据中国胃肠肿瘤外科联盟收集2014年至2016年间3年来自全国73家中心88000余例胃癌手术病例数据来看，接受腔镜手术患者的比例已超过30%，并呈每年上升趋势。由于腹腔镜手术具有微创、视野放大、操作精细、便于沟通、交流及学习等特点，其将具有更广阔的应用前景。本文结合笔者团队既往的经验，讨论腹腔镜下胃癌淋巴结清扫的特点。希望借此文对读者有所启发。

Issues of lymphadenectomy in laparoscopic gastrectomy for gastric cancer

There once remained a controversy concerning the range of lymphadenectomy between Eastern and Western scholars; however, based on the results from 15-year follow-up Dunch trial in 2010, D2 lymphadenectomy has been generally accepted as the standard surgical procedure for gastric cancer treatment. So far, the foundation for laparoscopic lymphadenectomy in gastric cancer surgery has been set up, and a new era of surgical treatment for gastric cancer has arisen. In 1994, Prof. Kitano performed the first laparoscopic surgery for early gastric cancer, since when increasing evidence has proved that laparoscopic surgery can replace partial open surgery and has already been recommended by the Japanese Gastric Cancer Treatment Guidelines as a standard treatment option for early distal gastric cancer. In China, according to the data collected by China Gastrointestinal Cancer Surgery union(CGCSU) from 2014 to 2016, among 88, 000 cases of gastric cancer in 73 centres across the country, the proportion of laparoscopic surgeries have exceeded 30%, accompanied by a yearly rise trend. Laparoscopic surgery is characterized by its minimally invasive, magnified field of vision, fine operation, as well as easier instruction and communication, it will have broad application prospects. This article combines the previous experience of the author team to discuss the issues related to laparoscopic lymphadenectomy. We hope this article could be inspiring to the readers.