探讨腹腔镜下脾门区淋巴结清扫保脾术治疗胃癌的入路选择，并对其安全性进行比较。

回顾性分析2015年1月至2018年1月接受腹腔镜下脾门区淋巴结清扫保脾术治疗的71例胃癌患者的临床资料，根据手术入路不同分为左侧入路组39例，胰后入路组32例。数据处理应用统计学软件SPSS22.0完成。手术相关指标、术后6个月的生活质量评分等数据采用(±s)表示，独立t检验；并发症发生率采用χ²检验；P<0.05差异有统计学意义。

左侧入路组患者手术时间、术中出血量、肛门排气时间均少于胰后入路组(均P<0.05)、淋巴结清扫数目多于胰后入路组(P<0.05)。两组患者术后并发症发生率和6个月的生活质量各维度评分的差异均无统计学意义(均P>0.05)。

左侧入路清扫淋巴结数目更多，手术时间、术中出血量及术后恢复时间均较短，手术效果更显著，值得推广应用。

To investigate the approaches of laparoscopic splenic hilar lymph node dissection for the treatment of gastric cancer and to compare their safety.

The clinical data of 71 patients with gastric cancer who underwent laparoscopic splenic hilar lymph node dissection in our hospital from January 2015 to January 2018 were retrospectively analyzed. According to the surgical approach, 39 cases were divided into left side approach group, 32 patients were divided into retrograde pancreatic approach group, the surgical indicators, complications rate, and postoperative quality of life scores were analyzed and compared. Data analysis was performed by statistical software SPSS22.0. Surgery-related indicators and quality of life scores at 6 months after surgery were expressed as (±s), and compared by the independent t test. The complication rate was compared by four-segment χ² test. P<0.05 was considered statistically significant.

The operative time, intraoperative blood loss, and anal exhaustion time in the left side approach group were all shorter than those in the retrograde pancreatic approach group (all P<0.05) and lymph node dissection was much more than that in the retrograde pancreatic approach group (P<0.05). The complication rate in the left side approach group was lower than that in the retrograde pancreatic approach group, but the difference was not statistically significant (P>0.05). There was no significant difference in the scores of quality of life for the 6 months after operation between the two groups (all P>0.05).

The complication rate and quality of life scores for the treatment of gastric cancer with laparoscopic hilar splenic lymph node dissection in the left approach and the posterior approach are all comparable, but the number of lymph nodes in the left approach is much more, and the operation time and intraoperative bleeding, and postoperative recovery time are shorter, the effect of surgery is better, and it is worthy of popularization and application.