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拟行No.16淋巴结清扫的胃癌病人须行充分的术前评估及术前分期,经过多学科讨论决定个体化治疗方案。目前,预防性No.16淋巴结清扫的临床意义已被否定,治疗性No.16淋巴结清扫目前仍有争议。其指征包括无其他非根治因素及No.16淋巴结转移不超过3枚。手术多采用右侧入路(右侧Toldts间隙),清扫范围主要集中于No.16a2和b1区。No.16淋巴结清扫并不增加手术并发症发生率,但术者需具有丰富的D2淋巴结清扫和扩大淋巴结清扫经验。新辅助化疗可使肿瘤降期,增加R0手术的机会。
Patients scheduled for gastric cancer with No.16 lymph node dissection need to undergo adequate preoperative assessment and preoperative staging, and decide on individualized treatment plans through multidisciplinary discussion. Currently, the clinical significance of prophylactic No.16 lymph node dissection has been negated, therapeutic No.16 lymph node dissection is still controversial. Indications include no other non-curative factors and No.16 no more than 3 lymph node metastases. Surgical use of the right side of the road (right Toldts gap), the cleaning range mainly in the No.16a2 and b1 area. No.16 lymph node dissection does not increase the incidence of surgical complications, but surgeons need to have rich experience of D2 lymph node dissection and lymph node dissection. Neoadjuvant chemotherapy can make the tumor fall, increasing the chance of R0 surgery.