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中华普外科手术学杂志(电子版)

中华普外科手术学杂志(电子版) ›› 2018, Vol. 12 ›› Issue (02) : 95 -98. doi: 10.3877/cma.j.issn.1674-3946.2018.02.002

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腹腔镜胃癌根治术保脾脾门淋巴结清扫术技巧及意义
杜晓辉1,†(), 胡时栋1   
  1. 1. 100853　北京，解放军总医院普通外科
  • 收稿日期:2017-12-15 出版日期:2018-02-26
  • 通信作者: 杜晓辉

Surgical skills and clinical significance of spleen-preserving splenic hilar lymphadenectomy in laparoscopic gastrectomy

Xiaohui Du1,†(), Shidong Hu1   

  1. 1. Department of general surgery, PLA gerneral hospital, Beijing 100853, China
  • Received:2017-12-15 Published:2018-02-26
  • Corresponding author: Xiaohui Du
  • About author:
    Corresponding author: Du Xiaohui, Email:
  • Supported by:
    Natural Science Fundation of China(NO. 61471397, 61170123 and 60601018); Natural Science Fundation of Hainan Province(NO. 813226); 11th 5-year Science and technology project of PLA(NO. 06G107); Science and technology Nova plan of Beijing city(NO. 2006A51); 10th 5-year Key project of PLA(NO. 04Z019)
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杜晓辉, 胡时栋. 腹腔镜胃癌根治术保脾脾门淋巴结清扫术技巧及意义[J]. 中华普外科手术学杂志(电子版), 2018, 12(02): 95-98.

Xiaohui Du, Shidong Hu. Surgical skills and clinical significance of spleen-preserving splenic hilar lymphadenectomy in laparoscopic gastrectomy[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2018, 12(02): 95-98.

中上部胃癌易发生脾门淋巴结转移，脾门淋巴结清扫是胃癌D2淋巴结清扫术重要部分。脾门结构及血管分布复杂，一定程度限制了保脾淋巴结清扫的应用。随着外科设备及技术的发展，保脾脾门淋巴结清扫术逐渐受到认可及应用。选择合适的手术入路及防控术中出血，腹腔镜胃癌根治术保脾脾门淋巴结清扫术具有良好的近远期疗效，有望成为胃癌根治术的标准之一。

关键词: 胃肿瘤, 腹腔镜检查, 淋巴结切除术

Splenic hilar lymph nodes metastasis are prone to occurred in patients with middle-upper gastric cancer, therefore splenic hilar lymphadenectomy is recognized as an important part of the D2 lymph nodes dissection of gastric cancer. However, due to complicated distribution of splenic vessels, clinical application of spleen-preserving splenic hilar lymphadenectomy are limited. With the development of surgical equipment and technology, spleen-preserving splenic hilar lymphadenectomy is gradually recognized and applied. Laparoscopic pleen-preserving splenic hilar lymphadenectomy could achieve satisfactory clinical outcome in treating patients with gastric cancer, by appropriate surgical approaches and intraoperatie bleeding control, which might become one of the standard surgical methods of gastrectomy.

Key words: Stomach Neoplasms, Laparoscopy, Lymph Node Excision
[1]
Lin M, Huang CM, Zheng CH, et al. Totally laparoscopic total gastrectomy for locally advanced middle－upper－third gastric cancer[J]. J Vis Surg, 2017, 3:46.
[2]
Yu W, Choi GS, Chung HY. Randomized clinical trial of splenectomy versus splenic preservation in patients with proximal gastric cancer[J]. Br J Surg, 2006, 93(5):559-563.
[3]
Ikeguchi M, Kaibara N. Lymph node metastasis at the splenic hilum in proximal gastric cancer[J]. Am Surg, 2004, 70(7):645-648.
[4]
Monig SP, Collet PH, Baldus SE, et al. Splenectomy in proximal gastric cancer: frequency of lymph node metastasis to the splenic hilus[J]. J Surg Oncol, 2001, 76(2):89-92.
[5]
胡建昆，赵林勇．腹腔镜胃癌根治联合脏器切除的现状与发展[J/CD]．中华普外科手术学杂志(电子版)，2017,11(6):457-460.
[6]
Huang CM, Zhang JR, Zheng CH, et al. A 346 case analysis for laparoscopic spleen－preserving no.10 lymph node dissection for proximal gastric cancer: a single center study[J]. PLoS One, 2014, 9(9):e108480.
[7]
Zhu GL, Sun Z, Wang ZN, et al. Splenic hilar lymph node metastasis independently predicts poor survival for patients with gastric cancers in the upper and/or the middle third of the stomach[J]. J Surg Oncol, 2012, 105(8):786-792.
[8]
Japanese Gastric Cancer Association.Japanese classification of gastric carcinoma: 3rd English edition[J]. Gastric Cancer, 2011, 14(2):101-112.
[9]
Nakayama K. Pancreaticosplenectomy combined with gastrectomy in cancer of the stomach[J]. Surgery, 1956, 40(2):297-310.
[10]
Brunschwig A. Pancreato－total gastrectomy and splenectomy for advanced carcinoma of the stomach[J]. Cancer, 1948, 1(3):427-430.
[11]
Maruyama K, Sasako M, Kinoshita T, et al. Pancreas－preserving total gastrectomy for proximal gastric cancer[J]. World J Surg, 1995, 19(4):532-536.
[12]
Okajima K, Isozaki H. Splenectomy for treatment of gastric cancer: Japanese experience[J]. World J Surg, 1995, 19(4):537-540.
[13]
Kitamura K, Nishida S, Ichikawa D, et al. No survival benefit from combined pancreaticosplenectomy and total gastrectomy for gastric cancer[J]. Br J Surg, 1999, 86(1):119-122.
[14]
李卓毅，傅俊惠，郑春鹏，等. 腹腔镜辅助进展期近端胃癌NO.10淋巴结的清扫技巧及意义[J]. 中国医药科学，2015, 5(8):140-142.
[15]
Yang K, Chen XZ, Hu JK, et al. Effectiveness and safety of splenectomy for gastric carcinoma: a meta－analysis[J]. World J Gastroenterol, 2009, 15(42):5352-5359.
[16]
黄昌明，郑志芳，林密．腹腔镜胃癌根治术保脾脾门淋巴结清扫术[J/CD]．中华普外科手术学杂志(电子版)，2017,11(6)．
[17]
黄昌明，陈起跃. "黄氏三步法"腹腔镜保脾脾门淋巴结清扫术要点及技巧[J]. 中国普通外科杂志，2016,25(10):1373-1376.
[18]
李国新，牟廷裕，余江，等. 胰后入路保留胰脾的原位脾门淋巴结清扫在腹腔镜胃癌根治术中的应用[J]. 中华消化外科杂志，2012, 11(1):58-60.
[19]
Hyung WJ, Lim JS, Song J, et al. Laparoscopic spleen－preserving splenic hilar lymph node dissection during total gastrectomy for gastric cancer[J]. J Am Coll Surg, 2008, 207(2):e6-11.
[20]
黄昌明，陈起跃. 腹腔镜胃癌根治术保脾脾门淋巴结清扫出血预防与处理[J]. 中国实用外科杂志，2017, 37(4):366-369.
[21]
Kinoshita T, Shibasaki H, Enomoto N, et al. Laparoscopic splenic hilar lymph node dissection for proximal gastric cancer using integrated three－dimensional anatomic simulation software[J]. Surg Endosc, 2016, 30(6):2613-2619.
[22]
Sakaguchi T, Sawada H, Yamada Y, et al. Indication of splenectomy for gastric carcinoma involving the proximal part of the stomach[J]. Hepatogastroenterology, 2001, 48(38):603-605.
[23]
Takayama T, Wakatsuki K, Matsumoto S, et al. Prognostic significance of splenic hilar nodal involvement in proximal third gastric carcinoma[J]. Hepatogastroenterology, 2011, 58(106):647-651.
[24]
Huang CM, Chen T, Lin JX, et al. The effects of laparoscopic spleen－preserving splenic hilar lymphadenectomy on the surgical outcome of proximal gastric cancer: a propensity score－matched, case－control study[J]. Surg Endosc, 2017, 31(3):1383-1392.
[25]
Oh SJ, Hyung WJ, Li C, et al. The effect of spleen－preserving lymphadenectomy on surgical outcomes of locally advanced proximal gastric cancer[J]. J Surg Oncol, 2009, 99(5):275-280.
[26]
Nashimoto A, Yabusaki H, Matsuki A. The significance of splenectomy for advanced proximal gastric cancer[J]. Int J Surg Oncol, 2012, 2012:301530.
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