作者：薛玉玲，熊文俊，朱晓峰，郑燕生，罗立杰，李金，罗思静，徐钰婷，王伟

单位：广州中医药大学第二临床医学院 胃肠外科，广东 广州 510120

Authors:  Xue Yuling, XiongWenjun, Zhu Xiaofeng, Zheng Yansheng, Lou Lijie, Li Jin, Luo Sijing, Xu Yuting, WangWei

Unit:  Department of Gastrointestinal Surgery, Guangdong Province Hospital of Traditional Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou 510120, Guangdong, China

摘要：

目的 探讨治疗性腹腔镜胃癌腹主动脉旁淋巴结清扫术的安全性和有效性。方法 回顾性分析2017年1月至2018年12月就诊广东省中医院胃肠外科实施治疗性腹腔镜胃癌腹主动脉旁淋巴结术的6例病人基线资料、术中及术后短期结果。结果 6例病人术前经影像学评估均存在第16组淋巴结转移,无其他远处转移,经转化治疗后,均达到部分缓解并顺利完成腹腔镜胃癌D2根治并腹主动脉旁淋巴结清扫术,术中1例因合并胰腺侵犯而联合行胰体尾+脾切除术,无中转开腹、腹腔出血、脏器损伤等并发症发生;中位手术时长482.5(445,510) min;中位淋巴结清扫总数、腹主动脉旁淋巴结(para-aortic lymph nodes, PALN)清扫总数及PALN阳性数目分别为50 (16,80)枚、18(3,31)枚、3.5(0,15)枚,其中5例PALN病理阳性,1例阴性;术后1例出现胰瘘,1例胸腔积液,1例腹泻,Clavien-Dindo分级均为2级,经对症治疗后均好转出院;术后中位住院时间17(6,30)天,术后30天内无二次手术及死亡发生;中位随访时间13.25(10～18)月,3例病人因肿瘤复发死亡,术后存活时间10～18月,余3例均未见肿瘤复发转移。结论 治疗性腹腔镜腹主动脉旁淋巴结清扫术在技术上是可行的,对于胃癌合并PALN转移的患者。

关键词：  腹腔镜; 胃癌; 治疗性腹主动脉旁淋巴结清扫; 操作技巧; 临床意义

Abstract：

Objective To evaluate the safety and effectiveness of therapeutic laparoscopic para-aortic lymph node dissection for gastric cancer. Methods We have collected and retrospectively analyzed the data of 6 patients who underwent therapeutic laparoscopic para-aortic lymph node surgery for gastric cancer at Guangdong hospital of traditional Chinese medicine from December 2017 to October 2018. Results All the six, had NO.16 lymph node metastasis confirmed by preoperative imaging test and no other distant metastasis, achieved PR and successfully completed the operation after 3 SOX conversion chemotherapy, one of whom combined with pancreaticotomy and splenectomy due to pancreatic invasion, with no conversion to laparotomy, abdominal bleeding, viscera injury. Median surgery time was 482.5 (445-510) minutes. The median total number of lymph node dissection, PALIN dissection and positive PALN were 50 (16-80), 18 (3-31), and 3.5 (0-15), respectively, with five PALN pathologically positive and one negative. Three patients occurred postoperative complications, including one pancreatic fistula, one pleural effusion and one diarrhea, cured with appropriate treatment. Median postoperative hospitalization day was 17 (6-30), with no second operation or death occurred. Median month of follow-up was 13.25 (10-18). Three patients died due to tumor recurrence, whose postoperative survival time was 10 -18 months, with the remaining no tumor recurrence or metastasis. Conclusion Therapeutic laparoscopic para-aortic lymph node dissection is feasible, the experienced centers can try, but its clinical efficacy needs to be further demonstrated.

Key Words:  Laparoscopy; Gastric cancer; Therapeutic para-aortic lymph node dissection; Operating skills; Clinical significance