Department of Surgery, Osaka Red Cross Hospital, Osaka, Japan.
Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan.
Asian J Endosc Surg. 2021 Jan;14(1):28-33. doi: 10.1111/ases.12820. Epub 2020 Jul 7.
Appropriate dissection of the infrapyloric lymph nodes (no. 6 LNs) is important in gastric cancer surgery. In laparoscopic surgery, dissection of the no. 6 LNs along the inner dissectable layer from the left side of patient has been reported. However, it is difficult for surgeons to provide appropriate traction with their left hand from the left side. To resolve this difficulty, we dissected the no. 6 LNs from the patient's right side to identify the optimal layer. We then evaluated the oncologic reliability of the layer and the safety of this procedure.
From the patient's right side, the surgeon used their left hand to provide appropriate traction when pulling the adipose tissue, including the no. 6 LNs. This exposed the optimal layer between the adipose tissue and the pancreas. To assess this maneuver, the surgical outcomes of patients who underwent laparoscopic distal gastrectomy from April 2011 to March 2013 were retrospectively analyzed. The surgical outcomes included the number of the no. 6 LNs resected, time to dissect the no. 6 LNs, incidence of pancreatic complications, and recurrence in the no. 6 LNs.
There were 112 patients identified. The median number of the no. 6 LNs resected was five. The median time to dissect the no. 6 LNs was 14 minutes. Four patients developed pancreatic fistula, and another four patients developed intra-abdominal abscess. There was no recurrence in the no. 6 LNs.
The optimal layer was oncologically reliable, and these procedures were safe.
在胃癌手术中，适当解剖胃下（No.6）淋巴结非常重要。在腹腔镜手术中，已经有报道称从患者左侧沿着可解剖的内层解剖 No.6 淋巴结。然而，对于外科医生来说，用左手从左侧提供适当的牵引是很困难的。为了解决这个困难，我们从患者的右侧解剖 No.6 淋巴结，以确定最佳的解剖层。然后，我们评估了该层的肿瘤学可靠性和该手术的安全性。
从患者的右侧，外科医生用左手在牵拉脂肪组织（包括 No.6 淋巴结）时提供适当的牵引。这暴露了脂肪组织和胰腺之间的最佳层。为了评估这一操作，我们回顾性分析了 2011 年 4 月至 2013 年 3 月间接受腹腔镜远端胃切除术的患者的手术结果。手术结果包括切除的 No.6 淋巴结数量、解剖 No.6 淋巴结的时间、胰腺并发症的发生率和 No.6 淋巴结的复发情况。
共确定了 112 名患者。No.6 淋巴结的中位数为 5 个。解剖 No.6 淋巴结的中位数时间为 14 分钟。有 4 例患者发生胰瘘，另有 4 例患者发生腹腔脓肿。No.6 淋巴结无复发。
最佳解剖层在肿瘤学上是可靠的，这些操作是安全的。
