中上部进展期胃癌腹腔镜保留胰脾清扫No．10、11淋巴结的技巧

目的探讨中上部进展期胃癌腹腔镜手术保留胰脾时，清扫No．10、11淋巴结的技巧。方法回顾性分析2012年1月～2013年6月86例腹腔镜保留胰脾清扫N0．10、11淋巴结的中上部进展期胃癌的临床资料及手术情况。结果清扫N0．10淋巴结1～15个，（3．8±1．6）个，No．10淋巴结转移率15．1％（13／86）；清扫No．11淋巴结1～12个，（3．2±1．3）个，No．11淋巴结转移率11．6％（10／86）。无一例因术中损伤脾血管或脾实质而中转开腹。未出现No．10、11淋巴结清扫相关术后并发症（如脾门区出血、脾缺血或坏死、胰漏等）。结论中上部进展期胃癌腹腔镜手术保留胰脾清扫No．10、11淋巴结是安全、可行的术式。对脾门血管变异充分认识，仔细解剖和正确找到脾门区域淋巴结清扫的人口是彻底清扫No．10、11淋巴结的关键。

The Significance and Skill of Laparoscopic Spleen- and Pancreas-preserving Dissection of No. 10 and No. 11 Lymph Nodes in Advanced Upper-middle Gastric Cancer

Objective To investigate the significance and skill of laparoscopic spleen- and pancreas-preserving dissection of No. 10 and No. 11 lymph nodes in advanced upper-middle gastric cancer. Methods The clinical data and surgical procedure of 86 patients with advanced upper-middle gastric cancer undergoing laparoscopic spleen- and pancreas-preserving dissection of No. 10 and No. 11 lymph nodes were retrospectively analyzed. Results The average number of No. 10 lymph nodes dissected was 3.8 ± 1.6 （range, 1 - 15） , and the metastasis rate was 15.1% （13/86）. The average number of No. 11 lymph nodes dissected was 3.2 ± 1. 3 （ range, 1 - 12）, and the metastasis rate was 11.6% （10/86）. None of the cases were converted to open surgery due to splenic vein or parenchyma injury. No lymphadenectomy related complications, such as bleeding of splenic hilar, spleen ischemia or necrosis, or pancreatic leakage occurred. Conclusions Laparoscopic spleen- and pancreas-preserving dissection of No. 10 and No. 11 lymph nodes is feasible, safe and effective in advanced upper-middle gastric cancer. The key to complete dissection of lymph nodes is being familiar with the anatomy variance of splenic vessel, scrutinized dissection and accurate location of the entrance to lymph node dissection.