CAJ | 학술논문

目的探讨基于不同类型脾门血管解剖的腹腔镜胃上部癌脾门淋巴结清扫术的临床应用.方法回顾性分析2010年7月至201 1年3月福建医科大学附属协和医院收治的39例施行腹腔镜脾门淋巴结清扫的胃上部痛患者的临床资料和血管解剖资料,总结根据不同脾门血管类型采取的不同淋巴结清扫策略.结果本组39例患者手术成功实施,无中转开腹者,无因术中损伤脾血管或脾实质而行脾切除术者.患者脾动脉走行:Ⅰ型25例,Ⅱ型8例,Ⅲ型4例,Ⅳ型2例；脾动脉终末支分支:集中型28例,分散型11例；脾叶动脉:一支型3例,二支型24例,三支型11例,多支型1例.患者胃短血管平均数目为(3.2±1.4)支(2～6支),脾门淋巴结平均清扫时间为(30±7)min,脾门淋巴结平均清扫数目为(2.8±2.1)枚.患者术中平均出血量为(20 ±7)ml(0 ～55 ml)；术后平均住院时间为(10±1)d,术后并发症发生率为10％(4/39).全组患者获得随访,随访截至2012年3月,1例患者出现肝转移,无术后死亡患者.结论熟悉脾门部的血管解剖有利于腹腔镜胃上部癌脾门淋巴结清扫术的推广和应用.
목적 탐토기우불동류형비문혈관해부적복강경위상부암비문림파결청소술적림상응용.방법 회고성분석2010년7월지201 1년3월복건의과대학부속협화의원수치적39례시행복강경비문림파결청소적위상부통환자적림상자료화혈관해부자료,총결근거불동비문혈관류형채취적불동림파결청소책략.결과 본조39례환자수술성공실시,무중전개복자,무인술중손상비혈관혹비실질이행비절제술자.환자비동맥주행:Ⅰ형25례,Ⅱ형8례,Ⅲ형4례,Ⅳ형2례；비동맥종말지분지:집중형28례,분산형11례；비협동맥:일지형3례,이지형24례,삼지형11례,다지형1례.환자위단혈관평균수목위(3.2±1.4)지(2～6지),비문림파결평균청소시간위(30±7)min,비문림파결평균청소수목위(2.8±2.1)매.환자술중평균출혈량위(20 ±7)ml(0 ～55 ml)；술후평균주원시간위(10±1)d,술후병발증발생솔위10％(4/39).전조환자획득수방,수방절지2012년3월,1례환자출현간전이,무술후사망환자.결론숙실비문부적혈관해부유리우복강경위상부암비문림파결청소술적추엄화응용.
Objective To investigate the efficacy of laparoscopic spleen-preserving hilar lymph nodes dissection based on splenic hilar vascular anatomy.Methods From July 2010 to March 2011,the clinical data of 39 patients with advanced proximal gastric cancer who underwent laparoscopic spleen-preserving hilar lymph nodes dissection at the Union Hospital of Fujian Medical University were retrospectively analyzed.Different types of vascular anatomy were analyzed,and different methods of lymph node dissection in the splenic hilus were adopted accordingly.Results The operation was successfully performed on all the patients,with no conversion to open surgery or splenectomy due to splenic vascular or parenchyma injury.There were 4 types of splenic artery running,including type Ⅰ (25 patients),type Ⅱ (8 patients),type Ⅲ (4 patients) and type Ⅳ (2 patients).There were 2 types of the end branches of splenic artery,including concentrated type (28 patients) and dispersion type (11 patients).The splenic lobial vessels of all the patients were anatomically classified and divided into 4 types,including a single branch of splenic lobial vessels in 3 patients,2 branches in 24 patients,3 branches in 11 patients and multibranches in 1 patient.The mean number of short gastric vessels was 3.2 ± 1.4 (range,2-6).The time for dissection of the lymph nodes in the splenic hilum,number of lymph nodes dissected in the splenic hilum,volume of operative blood loss,duration of hospital stay and incidence of complications were ( 30 ±7)minutes,2.8 ±2.1,(20 ±7)ml (range,0-55 ml),(10 ± 1) days and 10％ (4/39).All patients were followed up until March,2012. One patient had hepatic metastasis,and no patient died postoperatively.Conclusion Familiar with the variation of splenic hllar vascular anatomy is helpful in mastering and promoting laparoscopic spleen-preserving hilar lymph nodes dissection.