Jin Guoliang, Duan Shuquan, Guan Ana, Wang Zhepeng, Zhang Ranhao, Qiao Wenjuan, Wang Qiuhong, Zheng Liansheng
Graduate School, Baotou Medical College, Baotou, Inner Mongolia, China.
Digestive Department, The Second Affiliated Hospital of Baotou Medical College, Baotou, Inner Mongolia, China.
Front Surg. 2024 Nov 20;11:1322079. doi: 10.3389/fsurg.2024.1322079. eCollection 2024.
To study the anatomic characteristics of gastric peritoneum fascia space and provide a safe surgical approach for laparoscopic radical gastrectomy.
The morphological characteristics of perigastric fascia and fascial space and the course of important blood vessels were observed and studied in 2 fresh adult cadavers, 5 formalin immersed cadavers and 56 patients undergoing total gastrectomy. The hemoglobin, albumin, prealbumin, total protein, operation time, intraoperative blood loss, number of lymph node dissection and the incidence of complications before and after laparoscopic total gastrectomy with different approaches were statistically analyzed.
Through dissecting the cadaver, it is found that the space of the posterior gastric fascia space is suitable for laparotomy and laparoscopic surgery. The space between the prepancreatic fascia and the posterior gastric fascia is located in a plane, and the posterior gastric fascial space is connected with the gastrosplenic space and hepatogastric space. Through three different plane approaches, all can enter the space without blood vessels and nerves, so as to achieve complete gastrectomy. Statistical analysis of patients undergoing total gastrectomy with different approaches showed that there was no significant difference in operation time, intraoperative blood loss, number of lymph node dissection and postoperative complications among the three approaches ( > 0.05). There was no significant difference in postoperative hemoglobin, albumin, prealbumin and total protein ( > 0.05).
The space of the posterior gastric fascia space is suitable for laparotomy and laparoscopic surgerythe application of the anatomical study of perigastric fascial space in laparoscopic radical resection of gastric cancer not only accords with the tumor-free principle of radical resection of tumor, improves the safety of operation, but also reduces the occurrence of complications such as bleeding and important organ injury.
研究胃周腹膜筋膜间隙的解剖学特点，为腹腔镜胃癌根治术提供安全的手术入路。
在2具新鲜成人尸体、5具甲醛固定尸体及56例行全胃切除术的患者中，观察研究胃周筋膜及筋膜间隙的形态特点和重要血管的走行。对不同入路腹腔镜全胃切除术前、后的血红蛋白、白蛋白、前白蛋白、总蛋白、手术时间、术中出血量、淋巴结清扫数目及并发症发生率进行统计学分析。
通过尸体解剖发现，胃后筋膜间隙空间适合开腹及腹腔镜手术。胰前筋膜与胃后筋膜之间的间隙位于同一平面，胃后筋膜间隙与胃脾间隙、肝胃间隙相通。通过三种不同平面入路均能进入无血管神经的间隙，从而完成全胃切除。对不同入路全胃切除术患者的统计学分析显示，三种入路在手术时间、术中出血量、淋巴结清扫数目及术后并发症方面差异无统计学意义（>0.05）。术后血红蛋白、白蛋白、前白蛋白及总蛋白差异无统计学意义（>0.05）。
胃后筋膜间隙空间适合开腹及腹腔镜手术，胃周筋膜间隙解剖学研究在腹腔镜胃癌根治术中的应用，不仅符合肿瘤根治性切除的无瘤原则，提高了手术安全性，还减少了出血、重要器官损伤等并发症的发生。
