腹腔镜下经前路清扫腹腔干区域淋巴结的临床体会

目的:探讨腹腔镜胃癌D2根治术中经前路清扫腹腔干区域7、8、9组淋巴结的安全性与可行性。方法:回顾分析2010年1月至2013年12月接受前路法腹腔镜下清扫7、8、9组淋巴结的21例患者的临床资料,清扫顺序:首次清扫12a(肝固有动脉周围淋巴结),其次清扫8a(肝总动脉周围淋巴结),再清扫第9组淋巴结(腹腔干淋巴结)及第7组淋巴结(胃左动脉周围淋巴结)。路径:不经胃后间隙,经胃小弯侧网膜囊间隙操作。结果:21例手术均获成功,无一例中转开腹。20例经胃前路成功行第7、8、9组淋巴结清扫,平均清扫淋巴结数量(9.7±2.4)枚,平均清扫时间(31.5±5.7)min,术中出血量极少。结论:经前路法腹腔镜清扫第7、8、9组淋巴结可降低手术配合要求、缩短手术时间,是安全、可行的。

Clinical experience of laparoscopic celiac trunk lymph nodes excision via left subhepatic space

Objective：To investigate the safety and feasibility of celiac trunk lymph nodes excision via left subhepatie space in laparoseopic D2 radical gastrectomy. Methods ： Clinical data of 21 patients who underwent laparoscopic lymph node exeision of station 7, 8,9 via subhepatic space from Jan. 2010 to Dec. 2013 were retrospectively analyzed. The excision order was station 12a （lymph nodes near proper hepatic artery） ,8a （lymph nodes around common hepatic artery）, 9 （celiac trunk lymph nodes ） and 7 （lymph nodes a- round left gastric artery）. Surgical approach：lymph nodes excision was performed via lesser omentum without retrogastric space dissec- tion. Results：All surgeries were successful without conversion. Lymph nodes excision of 7,8,9 group via subhcpatic space was success- ful in 20 cases. The average number of lymph nodes excised was （9.7 ± 2.4） and average time needed was （ 31.5 ±5.7 ） min. Little blood loss was observed. Conclusions：Laparoscopic lymph nodes station 7,8,9 dissection via subhepatic space is safe and ieasible with shorter operation time and less cooperation.