141例腹腔镜远端胃癌D2根治术No．6组淋巴结清扫的经验总结

目的探讨腹腔镜远端胃癌D2根治术No．6组淋巴结清扫的意义、方法及技巧。方法回顾性分析了笔者所在医院2008年1月1日至2011年12月31日4年期间141例行腹腔镜远端胃癌D2根治术No．6组淋巴结清扫术患者的临床资料。结果141例患者均顺利完成腹腔镜远端胃癌D2根治术No．6组淋巴结清扫术。随着手术病例的增多，手术时间、出血量、并发症发生率以及手术中转例数逐年下降，淋巴结清扫数目逐步增多（P〈0．0001）；无No．6组淋巴结清扫所致的死亡病例；结肠中血管、胰腺及胃十二指肠动脉是No．6组淋巴结清扫的重要解剖标志，横结肠系膜前后叶间隙和胰前间隙是进行No．6组淋巴结清扫的重要外科平面。结论一个团队只有完成一定量的手术并学会以结肠中血管、胰腺及胃十二指肠动脉为解剖标志，准确地识别横结肠系膜前后叶间隙及胰前间隙，在正确的外科平面进行操作，才能使No．6组淋巴结清扫术既符合肿瘤根治原则又能达到微创的目的。

Experience Summary on Group No.6 Lymphadenectomy of Laparoscopic Gastrectomy with D2 Lymph Node Dissec- tion for Distal Gastric Cancer in 141 Cases

Objective To study the significance, methods, and technique of group No.6 lymphadenectomy of the laparoscopic gastrectomy with D2 lymph node dissection for distal gastric cancer. Methods The relevant data of the 141 examples of group No.6 lymphadenectomy of the laparoscopic gastrectomy with D2 lymph node dissection for distal gastric cancer from Jan.l, 2008 to Dec.31, 2011 were retrospectively analysized. Results One hundred and forty-one patients were successfully completed the group No.6 lymphadenectomy of laparoscopic distal gastrectomy with D2 lymph node dissection. With the number of cases of operation increasing, the operation time, bleeding volume, incidence rate of complication, and the number of operation transit cases stepped down year by year, and the number of the lymph node dissection stepped up （P〈0. 000 1）. No case died of the lymphadenectomy of the group No.6 lymph node. The medium vessels of colon, pancreas, and the gastroduodenal artery were the anatomic landmarks of the group No.6 lympha- denectomy. The space between the anterior lobe and the posterior lobe of transverse mesocolon and the prepancreatic space were the important surgical plane to carry out the group No.6 lymphadenectomy. Conclusions Only a team shall complete a certain amount of the operation, take the medium vessels of colon, pancreas, and the gastroduodenal artery as the anatomic landmark, accurately identify the space between the anterior lobe and the posterior lobe of transverse mesocolon, and the prepancreatic space, and take operation on the correct surgical plane, shall the group No.6 lymphadenectomy conform to the principle of the radical cure of the tumour and achieve the aim of the minimal invasion.