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目的:探讨改良手辅助腹腔镜根治性全胃切除术中脾门淋巴结清扫的安全性及可行性。方法:回顾性分析2012年6月—2013年7月8例胃癌患者采用改良手辅助腹腔镜全胃切除+脾门淋巴结清扫患者的临床资料。结果:8例患者手术均成功实施,无中转开腹者,无因术中损伤脾血管或脾实质而行脾切除术者。8例患者共清扫脾门淋巴结27枚,阳性淋巴结3枚(11.1%);脾门淋巴结清扫时间平均为23 min,患者术中平均出血量为176 mL,平均住院时间为9.5 d;术后出现肺部感染1例,术后平均累计随访时间为3.6个月,无肿瘤复发及死亡病例,患者精神状态均良好。结论:运用改良手辅助腹腔镜技术清扫脾门淋巴结安全可行,远期疗效有待进一步研究。
Objective: To explore the safety and feasibility of modified hand-assisted laparoscopic radical gastrectomy for splenic lymph nodes dissection. Methods: The clinical data of 8 patients with gastric cancer who underwent laparoscopic total gastrectomy + splenic lymph node dissection from June 2012 to July 2013 were analyzed retrospectively. Results: All the 8 patients underwent surgery successfully. There were no patients who underwent laparotomy for splenectomy due to intraoperative injury of splenic blood vessels or splenic parenchyma. In the 8 patients, 27 splenic lymph nodes and 3 positive lymph nodes were obtained (11.1%). The mean lymphadenectasis time was 23 min. The mean intraoperative blood loss was 176 mL and the average hospital stay was 9.5 days. One case of pulmonary infection, the average cumulative follow-up time was 3.6 months, no tumor recurrence and death, the patient’s mental state are good. Conclusion: It is safe and feasible to use the improved hand-assisted laparoscopy to clear the splenic lymph nodes. The long-term curative effect remains to be further studied.