Ikeda Taro, Kanaji Shingo, Takiguchi Gosuke, Urakawa Naoki, Hasegawa Hiroshi, Yamamoto Masashi, Matsuda Yoshiko, Yamashita Kimihiro, Matsuda Takeru, Oshikiri Taro, Nakamura Tetsu, Suzuki Satoshi, Kakeji Yoshihiro
Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan.
Division of Minimally Invasive Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan.
SAGE Open Med. 2020 Jun 30;8:2050312120936918. doi: 10.1177/2050312120936918. eCollection 2020.
Dissection of the No. 11p lymph nodes is technically challenging because of variations in anatomical landmarks. This study aimed to determine the accuracy and efficacy of predicting the dorsal landmark of No. 11p lymph node using three-dimensional computed tomography simulation.
Laparoscopic gastrectomy with No. 11p lymph node dissection with preoperative simulation using three-dimensional computed tomography was performed in 24 patients at our institution from October 2016 to May 2018. Initially, preoperative three-dimensional computed tomography findings with operative videos in these 24 patients were compared. The dorsal landmark was defined as an anatomical structure behind the splenic artery on preoperative three-dimensional computed tomography and operative videos. The dorsal landmark of No. 11p lymph node was divided into four types: (1) splenic vein type, (2) splenic vein and pancreas type, (3) pancreas type, and (4) unclear type. Then, to investigate the efficacy of three-dimensional computed tomography, we compared the clinical and pathological features and surgical outcomes of nine patients who underwent preoperative three-dimensional computed tomography simulation (three-dimensional computed tomography group) and 23 patients who did not undergo three-dimensional computed tomography simulation from August 2014 to September 2016 (non-three-dimensional computed tomography group). All procedures were performed by one surgeon certified by the Endoscopic Surgical Skill Qualification System in Japan.
The concordance rate between three-dimensional computed tomography and operative videos of the dorsal landmark using three-dimensional computed tomography was 79% (19/24). The operative time of No. 11p lymph node dissection was significantly shorter in the three-dimensional computed tomography group than in the non-three-dimensional computed tomography group (7.7 versus 15.8 min, = 0.044).
The accuracy of predicting the dorsal landmark of No. 11p lymph node using three-dimensional computed tomography was extremely high. Preoperative simulation with three-dimensional computed tomography was useful in shortening the operative time of No. 11p lymph node dissection.
由于解剖标志的变异，第11p组淋巴结的清扫在技术上具有挑战性。本研究旨在确定使用三维计算机断层扫描模拟预测第11p组淋巴结背侧标志的准确性和有效性。
2016年10月至2018年5月，在本机构对24例患者进行了术前三维计算机断层扫描模拟的腹腔镜胃癌根治术并清扫第11p组淋巴结。首先，比较这24例患者术前三维计算机断层扫描结果与手术视频。背侧标志在术前三维计算机断层扫描和手术视频中被定义为脾动脉后方的解剖结构。第11p组淋巴结的背侧标志分为四种类型：（1）脾静脉型，（2）脾静脉和胰腺型，（3）胰腺型，（4）不明确型。然后，为了研究三维计算机断层扫描的有效性，我们比较了2014年8月至2016年9月接受术前三维计算机断层扫描模拟的9例患者（三维计算机断层扫描组）和未接受三维计算机断层扫描模拟的23例患者（非三维计算机断层扫描组）的临床和病理特征及手术结果。所有手术均由一名获得日本内镜外科技能资格系统认证的外科医生进行。
使用三维计算机断层扫描的背侧标志在三维计算机断层扫描与手术视频之间的符合率为79%（19/24）。三维计算机断层扫描组第11p组淋巴结清扫的手术时间明显短于非三维计算机断层扫描组（7.7分钟对15.8分钟，P = 0.044）。
使用三维计算机断层扫描预测第11p组淋巴结背侧标志的准确性极高。术前三维计算机断层扫描模拟有助于缩短第11p组淋巴结清扫的手术时间。
