Gastrointestinal Surgery Unit 1, Teaching Hospital of Putian First Hospital of Fujian Medical University.
Institute of Minimally Invasive Surgery.
Surg Laparosc Endosc Percutan Tech. 2021 Mar 12;31(4):434-438. doi: 10.1097/SLE.0000000000000886.
The aim was to investigate the anatomical layers of the specific fascia involved in infrapyloric lymphadenectomy in laparoscopic radical gastrectomy for gastric cancer and to analyze the short-term efficacy of an anatomy-guided surgical approach.
On the basis of many years of clinical practice in fascial anatomy-guided laparoscopic radical gastrectomy for gastric cancer, we proposed anatomical considerations for infrapyloric lymphadenectomy in this procedure and investigated the anatomy of the mesentery and mesenteric fusion in this region, including the specific starting and ending points and the plane of the operation. We also retrospectively analyzed the clinical data of 265 patients who underwent fascial anatomy-guided infrapyloric lymphadenectomy in laparoscopic radical gastrectomy for gastric cancer from January 2015 to January 2019 and compared the short-term efficacy between the fascial anatomy-guided laparoscopic infrapyloric lymphadenectomy plus mesogastric excision group and the laparoscopic infrapyloric lymphadenectomy group.
Extensive mesenteric fusion and folds exist in the infrapyloric region of the stomach, and removal of the medial fold (medial leg) and lateral fold (lateral leg) of the infrapyloric mesogastrium during surgery is easily missed, resulting in incomplete removal of the infrapyloric mesogastrium. Baseline data were comparable between the laparoscopic infrapyloric lymphadenectomy plus mesogastric excision group and the laparoscopic infrapyloric lymphadenectomy group. The mean operative time for infrapyloric lymphadenectomy, the number of positive lymph nodes harvested in the infrapyloric region, and the number of patients with mesenteric metastasis in the infrapyloric region were not significantly different (P>0.05). The number of harvested lymph nodes was higher in the laparoscopic infrapyloric lymphadenectomy plus mesogastric excision group than in the laparoscopic infrapyloric lymphadenectomy group (5.09±3.30 vs. 4.13±2.90, P<0.05), and intraoperative blood loss was lower in the former group than in the latter group (5.89±3.78 vs. 25.21±11.24 mL, P=0.000).
Fascial anatomy-guided laparoscopic infrapyloric lymphadenectomy enables systematic and complete removal of the lymph nodes and mesentery of the infrapyloric region with less intraoperative blood loss.
探讨腹腔镜胃癌根治术中参与幽门下淋巴结清扫的特定筋膜解剖层次，并分析解剖导向手术的短期疗效。
基于多年在胃癌筋膜解剖导向腹腔镜根治术中的临床实践，我们提出了该手术中幽门下淋巴结清扫的解剖学考虑因素，并对该区域的肠系膜和肠系膜融合进行了解剖学研究，包括具体的起止点和手术平面。我们还回顾性分析了 2015 年 1 月至 2019 年 1 月期间 265 例行筋膜解剖导向腹腔镜胃癌根治术中幽门下淋巴结清扫术的患者的临床资料，并比较了筋膜解剖导向腹腔镜幽门下淋巴结清扫加胃系膜切除术组与腹腔镜幽门下淋巴结清扫组的短期疗效。
胃幽门下区域广泛存在肠系膜融合和褶皱，手术中内侧折叠（内侧腿）和外侧折叠（外侧腿）的幽门下胃系膜容易被遗漏，导致幽门下胃系膜不完全切除。腹腔镜幽门下淋巴结清扫加胃系膜切除术组与腹腔镜幽门下淋巴结清扫组的基线资料无显著差异。幽门下淋巴结清扫的平均手术时间、幽门下区域阳性淋巴结的数量以及幽门下区域肠系膜转移的患者数量无显著差异（P>0.05）。腹腔镜幽门下淋巴结清扫加胃系膜切除术组的淋巴结清扫数量高于腹腔镜幽门下淋巴结清扫组（5.09±3.30 枚比 4.13±2.90 枚，P<0.05），且前者术中出血量低于后者（5.89±3.78 毫升比 25.21±11.24 毫升，P=0.000）。
筋膜解剖导向腹腔镜幽门下淋巴结清扫术可系统、完整地清扫幽门下区域的淋巴结和系膜，术中出血量较少。
