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目的探讨腹腔镜远端胃癌D2根治术No.6组淋巴结清扫的意义、方法及技巧。方法回顾性分析了笔者所在医院2008年1月1日至2011年12月31日4年期间141例行腹腔镜远端胃癌D2根治术No.6组淋巴结清扫术患者的临床资料。结果 141例患者均顺利完成腹腔镜远端胃癌D2根治术No.6组淋巴结清扫术。随着手术病例的增多,手术时间、出血量、并发症发生率以及手术中转例数逐年下降,淋巴结清扫数目逐步增多(P<0.000 1);无No.6组淋巴结清扫所致的死亡病例;结肠中血管、胰腺及胃十二指肠动脉是No.6组淋巴结清扫的重要解剖标志,横结肠系膜前后叶间隙和胰前间隙是进行No.6组淋巴结清扫的重要外科平面。结论一个团队只有完成一定量的手术并学会以结肠中血管、胰腺及胃十二指肠动脉为解剖标志,准确地识别横结肠系膜前后叶间隙及胰前间隙,在正确的外科平面进行操作,才能使No.6组淋巴结清扫术既符合肿瘤根治原则又能达到微创的目的。
Objective To investigate the significance, methods and skills of No.6 group lymph node dissection in D2 radical mastectomy of distal gastric cancer. Methods Retrospective analysis of the clinical data of 141 patients undergoing D2 laparoscopic distal gastric cancer with No.6 lymph node dissection in our hospital from January 1, 2008 to December 31, 2011 were retrospectively analyzed. Results All of the 141 patients successfully completed No.6 group of lymph node dissection in D2 radical distal laparoscopic gastric cancer. With the increase of operation cases, the operation time, the amount of bleeding, the complication rate and the number of cases transferred decreased year by year, and the number of lymph node dissection increased gradually (P <0.0001). No case of death caused by lymph node dissection in No.6 group was found. Colonic vessels, pancreas and gastroduodenal artery is an important anatomical landmark No.6 group lymph node dissection, transverse mesenteric anterior and posterior leaf space and anterior pancreas is the No.6 group lymph node dissection is an important surgical plane. Conclusion Only when a certain team completed a certain amount of surgery and learned to dissect the blood vessels, pancreas and gastroduodenal artery in the colon, accurately identify the anterior and posterior space of the transverse mesocolon and anterior pancreatic space, operate in the correct surgical plane, In order to make No.6 group lymphadenectomy both in line with the principles of radical tumor can achieve the purpose of minimally invasive.