胃癌根治术中No.12a淋巴结正确清扫的意义和技巧

目的探讨胃癌根治术中No.12a淋巴结清扫的意义和技巧。方法回顾性分析笔者所在科室行No.12a淋巴结清扫的68例Ⅳ期胃癌患者的临床资料,结合笔者的手术实践提出在胃癌根治术时,清扫该组淋巴结的经验和体会。结果 68例Ⅳ期胃癌中共检出No.12a淋巴结556枚(5～11枚/例),平均8.17枚/例,No.12a淋巴结转移率为33.27%(185/556)。本组病例术后无吻合口漏、淋巴管瘘、出血等并发症发生。结论熟悉肝固有动脉周围解剖以及鞘内淋巴结清扫,胃左静脉和胃右动脉自根部结扎以及门静脉前壁和胃十二指肠动脉的充分显露是彻底清扫No.12a淋巴结的关键。

Signficance and Surgical Skill for Lymphadenectomy of No.12a Lymph Node in Gastric Cancer

Objective To investigate the significance and surgical skill for lymphadenectomy of No.12a lymph node around proper hepatic artery in gastric cancer.Methods Among data of stageⅣ gastric cancer patients who received curative R0 gastrectomy,sixty-eight patients performed gastrectomy with D2 lymph node dissection,including No.12a lymph node were identified.Experiences and understanding of No.12a lymphadenectomy for gastric cancer were concluded.Results The number of dissected No.12a lymph node was 556(5-11 per capita,mean 8.17 per capita) in 68 patients with stageⅣ gastric cancer,and the positive lymph node of No.12a was 33.27%(185/556).There were no lymphadenectomy related complications: anastomotic leakage,lymphatic fistula,and postoperative hemorrhage in this series.Conclusions Being familiar with the anatomy around proper hepatic artery and intrathecal liberation of proper hepatic artery,ligation of left gastric vein and right gastric artery at its onset,and exposure of gastroduodenal artery’s root and anterior wall of portal vein are important to dissection of No.12a lymph nodes.