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目的探讨胃癌根治术中No.12a淋巴结清扫的意义和技巧。方法回顾性分析笔者所在科室行No.12a淋巴结清扫的68例Ⅳ期胃癌患者的临床资料,结合笔者的手术实践提出在胃癌根治术时,清扫该组淋巴结的经验和体会。结果 68例Ⅳ期胃癌中共检出No.12a淋巴结556枚(5～11枚/例),平均8.17枚/例,No.12a淋巴结转移率为33.27%(185/556)。本组病例术后无吻合口漏、淋巴管瘘、出血等并发症发生。结论熟悉肝固有动脉周围解剖以及鞘内淋巴结清扫,胃左静脉和胃右动脉自根部结扎以及门静脉前壁和胃十二指肠动脉的充分显露是彻底清扫No.12a淋巴结的关键。
Objective To investigate the significance and technique of No.12a lymph node dissection in radical resection of gastric cancer. Methods The clinical data of 68 patients with stage Ⅳ gastric cancer treated with No.12a lymph node dissection in our department were retrospectively analyzed. Combined with the author’s practice, we put forward the experience and experience of radical lymphadenectomy in gastric cancer. Results A total of 556 pieces (5 ~ 11 pieces / case) of No.12a lymph nodes were detected in 68 cases of stage Ⅳ gastric cancer, with an average of 8.17 cases / case. The lymph node metastasis rate of No.12a was 33.27% (185/556). No cases of anastomotic leakage in this group of patients, lymphatic fistula, bleeding and other complications. Conclusion Familiarization with the anatomy of the internal hepatic artery and the dissection of the intrathecal lymph nodes, the ligation of the left gastric vein and the right gastric artery from the root, and the adequate exposure of the anterior portal vein and the gastroduodenal artery are the keys to thoroughly dissecting No.12a lymph nodes.