腹腔镜远端胃癌根治术淋巴结清扫相关解剖学的临床应用研究

目的：研究腹腔镜远端胃癌根治术淋巴结清扫相关解剖学特点，探讨腹腔镜下实施淋巴结清扫的正确方法和技巧。方法：通过29例腹腔镜远端胃癌根治手术和6具人体标本解剖，观察胃癌根治术D2淋巴结清扫的镜下解剖学定位标志、可利用的解剖间隙以及与开放手术的差异。结果：25例在腹腔镜下完成手术，4例因肿瘤浸润、淋巴结融合固定而中转行姑息性切除手术，手术清扫的淋巴结数目为11～32个。腹腔镜远端胃癌D2根治术淋巴结清扫均位于韧带和系膜形成的潜在间隙内。胰腺、结肠中血管、胃左血管位置恒定而突出，在腔镜下易于识别，可作为腹腔镜下淋巴结清扫的定位标志。结论：利用镜下解剖定位标志，进入正确的解剖间隙进行清扫，更符合安全性的原则和肿瘤根治的规范。腹腔镜下的相关解剖学研究为腹腔镜胃癌根治手术提供了正确可靠的依据。

Clinical study on anatomic features of radical lymphadenectomy in laparoscopic surgery for distal gastric cancer

Objective:To study the anatomic features of radical lymphadenectomy in laparoscopic surgery for gastric cancer and find a proper approach for laparoscopic lymph nodes resection.Methods:Via 29 cases of laparoscopic radical resection of distal gastric cancer and 6 cadaver dissections,we obsered the anatomic mark point in laparoscopic vision, available anatomic space and the differences from open-operation.Results:Twenty-fire patients underwent laparoscopic radical gastrectomy, 4 patients had conversion to open surgery for tumor invasion or fixed lymph nodes. The number of harvested lymph nodes was 11~32.The potential space between mensentery and ligament. pancreas,middle colic vessel and left gastric vessel can be used as mark points for laparoscopic surgery for distal gastric cancer,due to their obvious and fixed site.Conclusions:Lymphadenectomy in the right space by use of anatomic mark point in laparoscopic vision is safer and more standardized.Laparoscopic anatomic features can provide theoretical basis for laparoscopic surgery for gastric cancer.