切换至 "中华医学电子期刊资源库"
高级检索
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) ›› 2021, Vol. 15 ›› Issue (02) : 123 -128. doi: 10.3877/cma.j.issn.1674-3946.2021.02.002

所属专题： 述评/论坛； 总编推荐； 文献；

专家论坛

中国腹腔镜胃癌手术20年发展、问题与对策
黄昌明1,†(), 陈起跃1, 刘治羽1, 钟情1   
  1. 1. 350001　福建医科大学附属协和医院胃外科
  • 收稿日期:2020-08-01 出版日期:2021-04-26
  • 通信作者: 黄昌明

Development, problems and countermeasures of laparoscopic radical gastrectomy for gastric cancer in China in the past 20 years

Changming Huang1,†(), Qiyue Chen1, Zhiyu Liu1, Qing Zhong1   

  1. 1. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
  • Received:2020-08-01 Published:2021-04-26
  • Corresponding author: Changming Huang
  • Supported by:
    Joint Funds for the Innovation of Science and Technology of Fujian Province(2018Y9041); China Scholarship Council(201908350095); National Natural Science Foundation of China(81802312;81871899)
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

黄昌明, 陈起跃, 刘治羽, 钟情. 中国腹腔镜胃癌手术20年发展、问题与对策[J]. 中华普外科手术学杂志(电子版), 2021, 15(02): 123-128.

Changming Huang, Qiyue Chen, Zhiyu Liu, Qing Zhong. Development, problems and countermeasures of laparoscopic radical gastrectomy for gastric cancer in China in the past 20 years[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2021, 15(02): 123-128.

尽管腹腔镜胃癌根治术在中国开展相对较晚，但是利用临床病例多等优势，近20年来发展迅速。对于腹腔镜在进展期胃癌根治术中应用，中国学者在手术疗效高级别循证医学研究、手术入路探索、吲哚菁绿(ICG)示踪辅助淋巴结清扫技术等方面取得可喜成绩。但是，在技术快速发展同时，仍存在过分强调临床病例积累，忽视技术开展的规范性及临床数据的积累与分析等问题。相信随着腹腔镜胃癌规范化培训体系、资质准入制度与手术质量控制机制的逐步建立与完善，多学科多中心协作与大数据分析的进行，腹腔镜胃癌手术将在胃癌的外科治疗中得到更全面、更规范的开展。

关键词: 胃肿瘤, 腹腔镜, 胃切除术, 中国, 临床研究, 进展

Although laparoscopic radical surgery for gastric cancer was developed relatively late in China, it has developed rapidly in the past 20 years by taking advantage of large number of clinical cases. For the application of laparoscopy in advanced gastric cancer radical surgery, Chinese scholars have obtained great achievements in high-level evidence-based medical research on surgical efficacy, surgical approach exploration, and indoxyanine green (ICG) tracing assisted lymph node dissection . However, with the rapid development of technology, there still exist problems that overemphasize the accumulation of clinical cases and ignore the normative development of technology and the accumulation and analysis of clinical data. It is believed that with the gradual establishment and improvement of standardized training system, qualification access system and surgical quality control mechanism, multi-disciplinary multi-center collaboration and big data analysis, laparoscopic gastric cancer surgery will be more comprehensive and more standardized in the surgical treatment of gastric cancer.

Key words: Stomach neoplasms, Laparoscopes, Gastrectomy, China, Clinical study, Advance
图1 裸化胃网膜右血管
图2 完成幽门下区域清扫后
图3 充分裸化胃左动脉
图4 胰腺上缘区域清扫后
图5 显露胃网膜左血管
图6 脾门区No.10，No.11d淋巴结清扫后
[1]
Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA: Cancer J Clin, 2018, 68(6): 394-424.
[2]
Chen WQ, Zheng RS, Baade PD, et al. Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016, 66(2): 115-132.
[3]
Kitano S, Iso Y, Moriyama M, et al. Laparoscopy-assisted Billroth I gastrectomy[J]. Surg Laparosc Endosc, 1994, 4(2): 146-148.
[4]
Torre LA, Siegel RL, Ward EM, et al. Global Cancer Incidence and Mortality Rates and Trends--An Update[J]. Cancer Epidemiol Biomarkers Prev, 2016, 25(1): 16-27.
[5]
Zhao JK, Wu M, Kim CH, et al. Jiangsu Four Cancers Study: a large case-control study of lung, liver, stomach, and esophageal cancers in Jiangsu Province, China[J]. Eur J Cancer Prev, 2017, 26(4): 357-364.
[6]
Kim HH, Hyung WJ, Cho GS, et al. Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report--a phase III multicenter, prospective, randomized Trial (KLASS Trial) [J]. Anna Surg, 2010, 251(3): 417-420.
[7]
Cho SY, Lee KS, Kim JH, et al. Effect of combined systematized behavioral modification education program with desmopressin in patients with nocturia: a prospective, multicenter, randomized, and parallel study[J]. Int Neurourol J, 2014, 18(4): 213-220.
[8]
Honda M, Hiki N, Kinoshita T, et al. Long-term Outcomes of Laparoscopic Versus Open Surgery for Clinical Stage I Gastric Cancer: The LOC-1 Study[J]. Ann Surg, 2016, 264(2): 214-222.
[9]
Kim W, Kim HH, Han SU, et al. Decreased Morbidity of Laparoscopic Distal Gastrectomy Compared With Open Distal Gastrectomy for Stage I Gastric Cancer: Short-term Outcomes From a Multicenter Randomized Controlled Trial (KLASS-01) [J]. Ann Surg, 2016, 263(1): 28-35.
[10]
Katai H, Mizusawa J, Katayama H, et al. Short-term surgical outcomes from a phase III study of laparoscopy-assisted versus open distal gastrectomy with nodal dissection for clinical stage IA/IB gastric cancer: Japan Clinical Oncology Group Study JCOG0912[J]. Gastric Cancer, 2017, 20(4): 699-708.
[11]
Huang CM, Zheng CH. Laparoscopic Gastrectomy for Gastric Cancer[J]. Springer, 2015.
[12]
Huang CM, Zheng CH, Li P, et al. Atlas of Laparoscopic Gastrectomy for Gastric Cancer[J]. Springer, 2019.
[13]
Chen QY, Huang CM, Lin JX, et al. Laparoscopic Infrapyloric Area Lymph Node Dissection with No. 14v Enlargement for Advanced Lower Gastric Cancer in Middle Colic Vein Approach[J]. Ann Surg Oncol, 2016, 23(3): 951.
[14]
Huang CM, Chen QY, Lin JX, et al. Laparoscopic Suprapancreatic Lymph Node Dissection for Advanced Gastric Cancer Using a Left-Sided Approach[J]. Ann Surg Oncol, 2015, 22(7): 2351.
[15]
Chen RF, Huang CM, Chen QY, et al. Why the Proximal Splenic Artery Approach is the Ideal Approach for Laparoscopic Suprapancreatic Lymph Node Dissection in Advanced Gastric Cancer? A Large-Scale Vascular-Anatomical-Based Study[J]. Medicine (Baltimore), 2015, 94(18): e832.
[16]
Liang H. Standardize the lymphadenectomy from the rules of lymph nodes metastasis for advanced gastric cancer (in Chinese) [J]. Chin J Gastrointest Surg, 2011, 14(2): 86-89.
[17]
Huang CM, Chen QY, Lin JX, et al. Laparoscopic spleen-preserving no. 10 lymph node dissection for advanced proximal gastric cancer using a left approach[J]. Ann Surg Oncol, 2014, 21(6): 2051.
[18]
Jia-Bin W, Chang-Ming H, Chao-Hui Z, et al. Laparoscopic spleen-preserving No. 10 lymph node dissection for advanced proximal gastric cancer in left approach: a new operation procedure[J]. World J Surg Oncol, 2012, 10: 241.
[19]
Huang CM, Chen QY, Lin JX, et al. Huang's three-step maneuver for laparoscopic spleen-preserving No. 10 lymph node dissection for advanced proximal gastric cancer[J]. Chin J Cancer Res, 2014, 26(2): 208-210.
[20]
Yu J, Hu J, Huang C, et al. The impact of age and comorbidity on postoperative complications in patients with advanced gastric cancer after laparoscopic D2 gastrectomy: results from the Chinese laparoscropic gastrointestinal surgery study (CLASS) group[J]. Eur J Surg Oncol, 2013, 39(10): 1144-1149.
[21]
Hu YF, Huang CM, Sun YH, et al. Morbidity and Mortality of Laparoscopic Versus Open D2 Distal Gastrectomy for Advanced Gastric Cancer: A Randomized Controlled Trial[J]. J Clin, 2016, 34(12): 1350-1357.
[22]
Yu J, Huang C, Sun Y, et al. Effect of Laparoscopic vs Open Distal Gastrectomy on 3-Year Disease-Free Survival in Patients With Locally Advanced Gastric Cancer: The CLASS-01 Randomized Clinical Trial[J]. JAMA, 2019, 321(20): 1983-1992.
[23]
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.
[24]
Sasada S, Ninomiya M, Nishizaki M, et al. Frequency of lymph node metastasis to the splenic hilus and effect of splenectomy in proximal gastric cancer[J]. Anticancer Res, 2009, 29(8): 3347-3351.
[25]
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.
[26]
Methasate A, Trakarnsanga A, Akaraviputh T, et al. Lymph node metastasis in gastric cancer: result of D2 dissection[J]. J Med Assoc Thai, 2010, 93(3): 310-317.
[27]
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.
[28]
Zhang CH, Wu AW, Li ZY, et al. [Analysis of splenic hilar lymph node metastasis in advanced gastric cancer and dissection techniques] [J]. Zhonghua Wei Chang Wai Ke Za Zhi, 2011, 14(8): 589-592.
[29]
Shin SH, Jung H, Choi SH, et al. Clinical significance of splenic hilar lymph node metastasis in proximal gastric cancer[J]. Ann Surg Oncol, 2009, 16(5): 1304-1309.
[30]
Guo X, Peng Z, Lv XH, et al. Randomized controlled trial comparing short-term outcomes of laparoscopic and open spleen-preserving splenic hilar lymphadenectomy for advanced proximal gastric cancer: An interim report[J]. J Surg Oncol, 2018, 118(8): 1264-1270.
[31]
Zhang CH, Zhan WH, He YL, et al. Spleen preservation in radical surgery for gastric cardia cancer[J]. Ann Surg Oncol, 2007, 14(4): 1312-1319.
[32]
Ma ZM, Shi G, Chen X, et al. Laparoscopic splenic hilar lymph node dissection for advanced gastric cancer: to be or not to be[J]. Ann Transl Med, 2019, 7(14): 343.
[33]
Zheng CH, Xu YC, Zhao G, et al. Safety and feasibility of laparoscopic spleen-preserving No. 10 lymph node dissection for locally advanced upper third gastric cancer: a prospective, multicenter clinical trial[J]. Surg Endosc, 2020, 34(11): 5062-5073.
[34]
Smith DD, Schwarz RR, Schwarz RE. Impact of total lymph node count on staging and survival after gastrectomy for gastric cancer: data from a large US-population database[J]. J Clin Oncol, 2005, 23(28): 7114-7124.
[35]
Son T, Hyung WJ, Lee JH, et al. Clinical implication of an insufficient number of examined lymph nodes after curative resection for gastric cancer[J]. Cancer, 2012, 118(19): 4687-4693.
[36]
Seevaratnam R, Bocicariu A, Cardoso R, et al. A meta-analysis of D1 versus D2 lymph node dissection[J]. Gastric Cancer, 2012, 15 Suppl 1: S60-S69.
[37]
Songun I, Putter H, Kranenbarg EMK, et al. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial[J]. Lancet Oncol, 2010, 11(5): 439-449.
[38]
Vahrmeijer AL, Hutteman M, van der Vorst JR, et al. Image-guided cancer surgery using near-infrared fluorescence[J]. Nat Rev Clin Oncol, 2013, 10(9): 507-518.
[39]
Valente SA, Al-Hilli Z, Radford DM, et al. Near Infrared Fluorescent Lymph Node Mapping with Indocyanine Green in Breast Cancer Patients: A Prospective Trial[J]. J Am Coll Surg, 2019, 228(4): 672-678.
[40]
Yamashita S, Tokuishi K, Anami K, et al. Video-assisted thoracoscopic indocyanine green fluorescence imaging system shows sentinel lymph nodes in non-small-cell lung cancer[J]. J Thorac Cardiovasc Surg, 2011, 141(1): 141-144.
[41]
Tajima Y, Murakami M, Yamazaki K, et al. Sentinel node mapping guided by indocyanine green fluorescence imaging during laparoscopic surgery in gastric cancer[J]. Ann Surg Oncol, 2010, 17(7): 1787-1793.
[42]
Yano K, Nimura H, Mitsumori N, et al. The efficiency of micrometastasis by sentinel node navigation surgery using indocyanine green and infrared ray laparoscopy system for gastric cancer[J]. Gastric Cancer, 2012, 15(3): 287-291.
[43]
Huh YJ, Lee HJ, Kim TH, et al. Efficacy of Assessing Intraoperative Bowel Perfusion with Near-Infrared Camera in Laparoscopic Gastric Cancer Surgery[J]. J Laparoendosc Adv Surg Tech A, 2019, 29(4): 476-483.
[44]
Chen QY, Xie JW, Zhong Q, et al. Safety and Efficacy of Indocyanine Green Tracer-Guided Lymph Node Dissection During Laparoscopic Radical Gastrectomy in Patients With Gastric Cancer: A Randomized Clinical Trial[J]. JAMA Surg, 2020, 155(4): 300-311.
[1] 李卫民, 陈军民, 黄艳丽, 范晓芳, 韩文, 贾磊, 张俊超, 瞿辰. 基于中国甲状腺超声报告与数据系统分析超声在不同大小甲状腺结节中的诊断价值[J]. 中华医学超声杂志（电子版）, 2023, 20(07): 743-748.
[2] 曹迪, 张玉茹. 经腹腔镜生物补片修补直肠癌根治术后盆底疝1例[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 115-116.
[3] 李凯, 陈淋, 向涵, 苏怀东, 张伟. 一种U型记忆合金线在经脐单孔腹腔镜阑尾切除术中的临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 15-15.
[4] 姚宏伟, 魏鹏宇, 高加勒, 张忠涛. 不断提高腹腔镜右半结肠癌D3根治术的规范化[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 1-4.
[5] 杜晓辉, 崔建新. 腹腔镜右半结肠癌D3根治术淋巴结清扫范围与策略[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 5-8.
[6] 周岩冰, 刘晓东. 腹腔镜右半结肠癌D3根治术消化道吻合重建方式的选择[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 9-13.
[7] 张焱辉, 张蛟, 朱志贤. 留置肛管在中低位直肠癌新辅助放化疗后腹腔镜TME术中的临床研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 25-28.
[8] 王春荣, 陈姜, 喻晨. 循Glisson蒂鞘外解剖、Laennec膜入路腹腔镜解剖性左半肝切除术临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 37-40.
[9] 李晓玉, 江庆, 汤海琴, 罗静枝. 围手术期综合管理对胆总管结石并急性胆管炎患者ERCP +LC术后心肌损伤的影响研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 57-60.
[10] 甄子铂, 刘金虎. 基于列线图模型探究静脉全身麻醉腹腔镜胆囊切除术患者术后肠道功能紊乱的影响因素[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 61-65.
[11] 逄世江, 黄艳艳, 朱冠烈. 改良π形吻合在腹腔镜全胃切除消化道重建中的安全性和有效性研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 66-69.
[12] 莫波, 王佩, 王恒, 何志军, 梁俊, 郝志楠. 腹腔镜胃癌根治术与改良胃癌根治术治疗早期胃癌的疗效[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 644-647.
[13] 鲁鑫, 许佳怡, 刘洋, 杨琴, 鞠雯雯, 徐缨龙. 早期LC术与PTCD续贯LC术治疗急性胆囊炎对患者肝功能及预后的影响比较[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 648-650.
[14] 陈大敏, 曹晓刚, 曹能琦. 肥胖对胃癌患者手术治疗效果的影响研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 651-653.
[15] 孙秀艳, 徐庆蕾, 马鹏涛, 胡志元, 郭传真, 祝成红. 腹腔镜胃癌根治术中患者体温变化与压力性损伤及受压部位微环境的相关性分析[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 480-484.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号