论文部分内容阅读
目的:探讨脾上优先暴露法在腹腔镜进展期胃上部癌保脾脾门淋巴结清扫术中的应用。方法:回顾性分析2012年10月至2014年8月宁波市第一人民医院采用脾上优先暴露法对19例进展期胃上部癌行腹腔镜根治性全胃切除并保脾脾门淋巴结清扫术病人的临床资料和术中、术后及并发症等情况。结果:19例均成功行腹腔镜保脾脾门淋巴结清扫术。总手术时间(234±30)min,术中出血量(161±82)m L;第10组淋巴结清扫时间为(36±8)min,出血量为(33±18)m L。每例病人淋巴结清扫数(32±9)枚、第10组淋巴结清扫数(2.8±0.9)枚。2例病人有4枚第10组淋巴结转移,转移率10.5%(2/19)。病人术后肛门排气时间(3.2±1.1)d,术后进流质时间(4.0±0.8)d,术后住院时间(16.5±5.4)d,无吻合口漏、腹腔大出血及围手术期死亡。结论:脾脏上方优先暴露法临床可行,在一定程度上降低进展期胃上部癌腹腔镜保脾脾门淋巴结清扫术的手术难度,短期疗效满意。
Objective: To investigate the application of spleen superiority exposure method in laparoscopic advanced gastric cancer spleen and spleen lymph node dissection. Methods: From October 2012 to August 2014, 19 patients with advanced gastric cancer undergoing laparoscopic radical gastrectomy and splenectomy for lymph node dissection were recruited in the First People’s Hospital of Ningbo City from October 2012 to August 2014. The patient’s clinical data and intraoperative, postoperative and complications and so on. Results: Laparoscopic splenectomy and lymphadenectomy were performed in all 19 cases. The total operative time (234 ± 30) min and intraoperative blood loss (161 ± 82) m L; the lymph node dissection time in group 10 was (36 ± 8) min and the amount of bleeding was (33 ± 18) m L. The number of lymphadenectomy (32 ± 9) and the number of lymphadenectasis in group 10 (2.8 ± 0.9) were shown in each case. Two patients had four episodes of group 10 lymph node metastasis, with a metastatic rate of 10.5% (2/19). The time of postoperative anal exhaust (3.2 ± 1.1) days, postoperative admission of liquid (4.0 ± 0.8) days and postoperative hospital stay (16.5 ± 5.4) days were the best. No anastomotic leakage, intraperitoneal hemorrhage and perioperative death occurred. Conclusion: The priority exposure method of spleen above is clinically feasible, which can reduce the operation difficulty of laparoscopic splenectomy and lymphadenectomy for advanced gastric cancer to a certain extent, and the short-term curative effect is satisfactory.