使用彭氏多功能手术解剖器的“刮吸解剖技术”进行胃癌手术的三步法系统性淋巴结清扫术。

Three-step method for systematic lymphadenectomy in gastric cancer surgery using the 'curettage and aspiration dissection technique' with Peng's multifunctional operative dissector.

机构信息

Department of General Surgery and Laboratory of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University, School of Medicine, 1665 Kongjiang Road, Shanghai 200092, China.

出版信息

World J Surg Oncol. 2014 Oct 24;12:322. doi: 10.1186/1477-7819-12-322.

DOI:10.1186/1477-7819-12-322

PMID:25344327

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4223739/

Abstract

BACKGROUND

Gastric cancer is one of the most common malignancies and is a leading cause of cancer death worldwide. Surgery is the most effective and successful method of treatment for gastric cancer, and systematic lymph node (LN) dissection is unquestionably the most effective procedure for treating LN metastases of gastric cancer. Systematic lymphadenectomy is the most important part of curative resection, but lymphadenectomy is also the most difficult procedure in gastric cancer surgery. The aim of this study is to report our three-step method for lymphadenectomy in gastric cancer.

METHODS

In this study, the lymph node stations and groups were defined according to the 13th edition of the Japanese Classification for Gastric Carcinoma. The authors' novel, simplified method consists of three steps: (1) the Kocher maneuver and dissection of the greater omentum together with the anterior sheet of the mesocolon, (2) dissection of the lesser omentum, and (3) lymphadenectomy following the main vessels. We primarily used Peng's multifunctional operative dissector, which combines four different functions (cutting, separating, aspirating and coagulating). Our systematic lymphadenectomy included three steps, and the main procedure started from right to left and in the caudal to cranial direction.

RESULTS

A total of 830 consecutive patients underwent our three-step-method systematic lymphadenectomy in advanced gastric cancer surgery. The mean operation time was 146 minutes, and the mean blood loss was 248 ml. The median postoperative hospital stay was 10.9±4.8 days. The median number of examined LN was 31.6 (range 17 to 72) per patient, and the median number of metastatic LN was 5.6 (range 0 to 42) per patient. The overall incidence of postoperative complications was 10.6%, and the rate of hospital death was 0.9%. The overall three-year survival rate was 52.6%.

CONCLUSIONS

Our three-step method for lymphadenectomy is easy to perform and is a useful procedure for gastric cancer surgery.

摘要

背景

胃癌是最常见的恶性肿瘤之一，也是全球癌症死亡的主要原因。手术是治疗胃癌最有效和最成功的方法，系统的淋巴结（LN）清扫无疑是治疗胃癌 LN 转移的最有效方法。系统淋巴结清扫是根治性切除的最重要部分，但淋巴结清扫也是胃癌手术中最困难的步骤。本研究旨在报告我们的胃癌三步法淋巴结清扫术。

方法

本研究根据第 13 版日本胃癌分类定义了淋巴结站和组。作者的新简化方法包括三个步骤：（1）Kocher 操作和大网膜前叶与横结肠系膜的联合解剖；（2）小网膜解剖；（3）主血管后淋巴结清扫。我们主要使用 Peng 的多功能手术解剖器，它结合了四种不同的功能（切割、分离、抽吸和凝固）。我们的系统淋巴结清扫包括三个步骤，主要手术从右到左、从尾到头进行。

结果

830 例进展期胃癌患者接受了我们的三步法系统淋巴结清扫术。手术时间平均为 146 分钟，出血量平均为 248ml。术后中位住院时间为 10.9±4.8 天。每位患者的中位检查淋巴结数为 31.6（范围为 17 至 72），每位患者的中位转移性淋巴结数为 5.6（范围为 0 至 42）。术后并发症总发生率为 10.6%，住院死亡率为 0.9%。总的三年生存率为 52.6%。