系膜解剖理念下胃癌远端系膜完整切除法及其对N0.4d组淋巴结清扫的影

doi:10.13418/j.issn.1001-165x.2025.6.16

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中国临床解剖学杂志 ›› 2025, Vol. 43 ›› Issue (6) : 724-729. DOI: 10.13418/j.issn.1001-165x.2025.6.16

临床研究

系膜解剖理念下胃癌远端系膜完整切除法及其对N0.4d组淋巴结清扫的影

张云飞¹，李瑞欣¹，王敬涛¹，汲翔¹，赵婷婷²，王国俊¹*

作者信息 +

The concept of mesenteric anatomy and the surgical method for complete resection of the distal mesentery in gastric cancer and its impact on lymph node dissection in the N0.4d group

Zhang Yunfei ¹, Li Ruixin¹, Wang Jingtao¹, Ji Xiang¹, Zhao Tingting², Wang Guojun¹*

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摘要

目的本研究旨在通过系膜解剖理念阐明胃系膜与横结肠系膜平面的正确解剖方法，评估其对胃癌远端系膜完整切除效果及N0.4d组淋巴结清扫的影响。方法回顾性分析2023年6月至2024年4月郑州大学第一附属医院胃肠外科行腹腔镜胃癌D2根治术治疗的62例患者的临床资料。根据对胃系膜同横结肠系膜间隙解剖方法不同分为系膜解剖组（33例）和传统清扫组（29例）。观察两组患者术后标本中胃系膜完整程度并对比分析两组患者术中系膜游离时间、术中出血量、第6及4d组淋巴结清扫数目及术后并发症等情况。术后采用门诊、信件及电话等方式进行随访，随访时间截至2024年9月1日。结果所有患者均顺利完成腹腔镜胃癌手术，两组患者的一般资料无明显差异（P>0.05）。同传统清扫组相比，系膜解剖组标本可见完整的“信封样”系膜切除，第4d组淋巴结清扫数目明显增加（13.55±6.20 vs 4.69±1.74, P<0.001）；两组在术中出血、系膜游离时间和第6组淋巴结清扫数目的差异无统计学意义。两组术后均未出现严重并发症。2组患者全部获得随访，中位随访时间为10个月（5~15个月）。随访期间传统清扫组1例患者于术后11月发现双侧卵巢转移并行手术治疗，无1例患者死亡。结论系膜解剖理念下胃系膜与横结肠系膜平面的正确解剖能够安全地取得更完整的系膜切除范围并彻底清扫第4d组淋巴结。

Abstract

Objective To elucidate the correct anatomical dissection planes between the gastric mesentery and transverse mesocolon based on the concept of mesenteric anatomy, to evaluate its impact on complete mesogastric excision and No.4d lymph node dissection in gastric cancer surgery. Methods The clinical data of 62 patients who underwent laparoscopic D2 radical gastrectomy in the Department of Gastrointestinal Surgery of the First Affiliated Hospital of Zhengzhou University from June 2023 to April 2024 were retrospectively analyzed. According to the different dissection methods of the gastric mesenteric space and the right transverse mesocolic space, they were divided into membrane dissection group (33 cases) and traditional dissection group (29 cases). The integrity of gastric mesangium in postoperative specimens of the two groups was observed, and the intraoperative mesangium free time, intraoperative blood loss, the number of lymph nodes dissection and postoperative complications in groups 6 and 4d were compared between the two groups. Follow-up was conducted by outpatient clinic, letter and telephone until September 1, 2024. Results All patients successfully completed laparoscopic surgery for gastric cancer, and there was no significant difference in general data between the two groups (P>0.05). Compared with the traditional dissection group, complete "envelope" mesengectomy was observed in the membrane dissection group, and the number of lymph node dissection was significantly increased (13.55±6.20 vs 4.69±1.74，P<0.001). There was no significant difference between the two groups in intraoperative bleeding, mesangial free time and the number of lymph nodes dissection in N0.6. No serious complications occurred in both groups. All patients in both groups were followed up for a median of 10 months (5-15 months). During the follow-up period, 1 patient in the traditional dissection group was found to have bilateral ovarian metastasis 11 months after surgery, and no patient died. Conclusions The correct dissection of the gastric mesangium and the right transverse mesocolic plane guided by the concept of membrane anatomy can safely obtain a more complete mesangectomy area and thorough dissection of N0.4d lymph nodes.

导出引用

张云飞, 李瑞欣, 王敬涛, 汲翔, 赵婷婷, 王国俊. 系膜解剖理念下胃癌远端系膜完整切除法及其对N0.4d组淋巴结清扫的影[J]. 中国临床解剖学杂志. 2025, 43(6): 724-729 https://doi.org/10.13418/j.issn.1001-165x.2025.6.16

Zhang Yunfei , Li Ruixin, Wang Jingtao, Ji Xiang, Zhao Tingting, Wang Guojun. The concept of mesenteric anatomy and the surgical method for complete resection of the distal mesentery in gastric cancer and its impact on lymph node dissection in the N0.4d group[J]. Chinese Journal of Clinical Anatomy. 2025, 43(6): 724-729 https://doi.org/10.13418/j.issn.1001-165x.2025.6.16

中图分类号： R656.6 R322

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