CAJ | 학술논문

腹腔镜胃癌手术作为一种微创的手术方式，已逐步被外科医师所接受并在世界范围内得到推广。然而，由于腹腔镜手术过程中不能获取全面的视野而难以建立组织间的三维关系，如果对胃周围血管变异缺乏有效的认识，术中可能造成胃周围血管的损伤，引起大量的出血并影响手术视野，甚至可能使手术的根治程度受损。我们根据腹腔镜胃癌手术操作步骤，将胃周血管分为幽门下、胰腺上及脾门3个区域，并对以上区域的常见血管变异情况进行了分析总结。我们认为，遵循正确的解剖间隙、熟悉胃周围血管及对其常见变异进行技巧性处理，有助于安全有效地完成手术，提高淋巴结清扫水平及减少术中副损伤。
복강경위암수술작위일충미창적수술방식，이축보피외과의사소접수병재세계범위내득도추엄。연이，유우복강경수술과정중불능획취전면적시야이난이건립조직간적삼유관계，여과대위주위혈관변이결핍유효적인식，술중가능조성위주위혈관적손상，인기대량적출혈병영향수술시야，심지가능사수술적근치정도수손。아문근거복강경위암수술조작보취，장위주혈관분위유문하、이선상급비문3개구역，병대이상구역적상견혈관변이정황진행료분석총결。아문인위，준순정학적해부간극、숙실위주위혈관급대기상견변이진행기교성처리，유조우안전유효지완성수술，제고림파결청소수평급감소술중부손상。
Laparoscopic gastric cancer surgery, which has been gradually accepted by surgeons and popularized worldwide, is a less invasive alternative compared with an open procedure. However, the lack of cognition of the variation in perigastric vessels, and the difficulty to obtain a full-view image and to estimate the three-dimensional (3D) relationships between organs during laparoscopic procedures may lead to unexpected injuries of these vessels, causing massive bleeding, which would prevent surgeon from having access to a good view of the operative field. We retrospectively summarize the data of laparoscopic gastric cancer operation in our hospital, separate the perigastric vessels into three areas according to the procedure, respectively the inferior pylorus, superior pancreas, and hilum of spleen, and analyze the common anatomical variation of vessels and its characters. We propose that, following the right anatomical spaces, the familiarity of perigastric vessels and skills of treating its common anatomical variations, may contribute to the safe and effective operation, improve the level of lymph node dissection, and reduce the injury in the operation.