CAJ | 학술논문

目的探讨腹腔镜远端胃癌D2淋巴结清扫入路的可行性及安全性.方法回顾性分析山西省人民医院普通外科2010年3月至2011年7月行腹腔镜辅助胃癌D2根治性切除的54例远端胃癌患者的临床资料.全组术中淋巴结廓清入路均遵循“胃结肠韧带→横结肠系膜前叶→胰腺被膜→4sb→4d→6→14v和8a→12a→9→7→11p及1→3→5→网膜囊”的次序,分析该廓清入路的可行性及肿瘤手术学结果的有效性.结果 54例患者手术时间(236±51) min,术中失血量(217±65) ml;近端切缘间距(4.5±2.4) cm,远端切缘距离(5.0±3.0) cm,标本切缘均阴性；淋巴结摘除数目(18±5)枚,阳性淋巴结平均0～14枚.术后胃管停留时间(5±2)d,尿管停留时间(2±1)d,术后进食时间(8±2)d,术后住院时间(15±4)d.随访(11±3)个月,局部复发死亡3例(5.6％).结论规范的腹腔镜远端胃癌D2外科清扫入路安全可行,手术肿瘤学结果达到了远端、近端无瘤残余的要求.
목적 탐토복강경원단위암D2림파결청소입로적가행성급안전성.방법 회고성분석산서성인민의원보통외과2010년3월지2011년7월행복강경보조위암D2근치성절제적54례원단위암환자적림상자료.전조술중림파결곽청입로균준순“위결장인대→횡결장계막전협→이선피막→4sb→4d→6→14v화8a→12a→9→7→11p급1→3→5→망막낭”적차서,분석해곽청입로적가행성급종류수술학결과적유효성.결과 54례환자수술시간(236±51) min,술중실혈량(217±65) ml;근단절연간거(4.5±2.4) cm,원단절연거리(5.0±3.0) cm,표본절연균음성；림파결적제수목(18±5)매,양성림파결평균0～14매.술후위관정류시간(5±2)d,뇨관정류시간(2±1)d,술후진식시간(8±2)d,술후주원시간(15±4)d.수방(11±3)개월,국부복발사망3례(5.6％).결론 규범적복강경원단위암D2외과청소입로안전가행,수술종류학결과체도료원단、근단무류잔여적요구.
Objectives To investigate the surgical approach,feasibility and surgical outcomes of laparascopic distal gastrectomy D2 (LDGD2).Methods Fifty-four patients who underwent LDGD2 were examined in terms of pathologic findings,operative outcomes,and complications.A simple and effective surgical procedure was as follows:gastrocolic ligament→transverse mesocolon anterior lobe→pancreatic capsule →4sb→4d→6→14v,8a→12a→9→7→11p,1→3 →5 →lesser omental bursa.Efficacy and feasibility of this procedure was analyzed.Results The mean operative time was (236±51) minutes,the mean number of lymph nodes was (18±5),the mean positive lymph nodes were 0-14,the mean blood loss was (217±65) ml,and postoperative mean hospital stay was (15±4) days.Conclusions LDGD2 for lower and lower-middle gastric cancer is feasible and safe,and can meet the oncological demand.