进展期胃上部癌腹腔镜保脾脾门淋巴结清扫术的难点与争议
Difficulties and disputes of laparoscopic spleen-preserving splenic hilar lymph node dissection for advanced upper gastric cancer
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摘要:
脾门淋巴结是进展期胃上部癌患者行D2 根治术中必须清扫的淋巴结。随着外科技术的进步和治疗理念的更新，保脾脾门淋巴结清扫术已被外科医师广泛接受并逐步开展。然而，由于脾门血管解剖复杂、脾门区域显露困难等因素，尤其在肥胖症患者中，腹腔镜保脾脾门淋巴结清扫术成为腹腔镜胃癌手术的技术难点。术者不仅需要具备娴熟的腹腔镜手术操作技能，还应熟识腹腔镜下脾门血管的解剖学特点，采取合理的手术入路和程序化的手术操作步骤，才能更好地施行腹腔镜保脾脾门淋巴结清扫术。同时，随着进展期胃上部癌腹腔镜保脾脾门淋巴结清扫术的开展，围绕该区域淋巴结清扫的相关问题仍存在争议。
Abstract:Splenic hilar lymph node must be dissected in D2 dissection for advanced upper gastric cancer. With the advances of surgical technology and updated treatment concept, spleen-preserving splenic hilar lymph node dissection has been widely accepted and gradually carried out by surgeons. However, laparoscopic spleen-preserving splenic hilar lymph node dissection has become a technical difficulty of laparoscopic surgery for gastric cancer due to complex anatomy of splenic hilar vessels and exposed difficulty in splenic hilar region, especially in obese patients. Surgeons not only have skillful laparoscopic techniques but also know anatomic characteristics of splenic hilar vascular well, and reasonable surgical approach and programmed surgical procedures can guarantee successful laparoscopic spleen-preserving splenic hilar lymph node dissection. Meanwhile, with the development of laparoscopic spleen-preserving splenic hilar lymph node dissection, there is also some disputes about lymph node dissection.
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