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自1991年日本Kitano等[1]率先开展腹腔镜早期胃癌根治术以来,腹腔镜胃癌手术适应证逐步扩大,由早期胃癌拓展到较早的进展期胃癌,淋巴结清扫范围亦由D1、D1+逐步发展到D2,1997年Goh等[2]首次将腹腔镜胃癌D2手术用于治疗进展期胃癌。近年来,越来越多的研究显示,局部进展期远端胃癌行腹腔镜辅助远端胃大部切除及D2淋巴结清扫安全可行,而且能达到与开腹手术相当的临床肿瘤学疗效[3-7]。但是,关于腹腔镜应用于局部进展期胃上部癌的疗效评价却罕见报道,腹腔镜技术能否应用于局部进展期胃上部癌的淋巴结清扫仍存较大争议。
Since 1991, Japan’s Kitano [1] took the lead in laparoscopic radical gastrectomy since the beginning of laparoscopic gastric cancer surgery indications gradually expanded from early gastric cancer to early advanced gastric cancer, lymphadenectasis by the gradual development of D1, D1 + To D2, Goh et al [2] in 1997 for the first time the laparoscopic D2 gastric cancer surgery for the treatment of advanced gastric cancer. In recent years, more and more studies have shown that laparoscopic assisted distal gastrectomy and D2 lymph node dissection are safe and feasible in the locally advanced distal gastric cancer, and the clinical oncology efficacy comparable to laparotomy [3- 7]. However, the clinical evaluation of laparoscopic application in locally advanced gastric cancer has rarely been reported. Whether laparoscopy can be applied to lymph node dissection in locally advanced gastric cancer remains controversial.