扶镜手在腹腔镜胃癌 D2根治术中淋巴结清扫的配合体会

摘要

Objective To summarize the coordination experience for lymph node dissection in laparoscopic D 2 radical gastrectomy for gastric cancer . Methods A retrospective analysis was made on clinical data of 162 cases of laparoscopic D 2 radical gastrectomy for gastric cancer in our department from October 2012 to March 2016.The maximum tumor diameter was 0.5-9 cm (3.8 ±3.4 cm).Attentions for laparoscopic assistant during lymph node dissection were summarized . Results The laparoscopic assisted D2 radical gastrectomy were successfully completed in all the 162 cases, including total gastrectomy in 101 cases and distal gastrectomy in 61 cases.The total operative time was (190.2 ±39.5) min and (154.7 ±27.5) min, respectively, the intraoperative bleeding was (90.7 ±78.2) ml and (59.6 ±30.9) ml, respectively, and the number of lymph node harvested was (28.0 ±8.8) and (23.0 ±6.9 ), respectively, in total gastrectomy and distal gastrectomy .The histological type was undifferentiated and low differentiated type in 62 cases, moderately differentiated type in 54 cases, and well differentiated type in 46 cases.Postoperative TNM staging showed stage Ⅰ in 30 cases, Ⅱ in 40 cases, Ⅲ in 55 cases, and Ⅳ in 37 cases. Conclusion Laparoscopic assistant should help surgeon a clear and stable vision for the safe and quick completion of the operation .%目的总结扶镜手在腹腔镜胃癌D2根治术中淋巴结清扫的配合体会。方法2012年10月～2016年3月完成腹腔镜胃癌D2根治术162例，肿瘤最大径0．5～9 cm，（3．8±3．4） cm。分析3个区淋巴结清扫的扶镜手注意事项。结果162例均成功完成腹腔镜辅助胃癌D2根治术，其中全胃切除101例，远端胃切除61例，手术时间分别为（190．2±39．5） min、（154．7±27．5）min，术中出血量（90．7±78．2）ml、（59．6±30．9）ml，淋巴结清扫数（28．0±8．8）枚、（23．0±6．9）枚。组织学分型：未分化或低分化型62例，中分化型54例，高分化型46例；术后TNM分期Ⅰ期30例，Ⅱ期40例，Ⅲ期55例，Ⅳ期37例。结论扶镜手要给术者一个清晰及稳定的画面，才能安全、快速完成手术。