胃癌D2根治术课件

熟悉外科解剖规范手术操作远端胃癌D2根治术前胃癌严重危害着我国国民的健康,高居消化道肿瘤发病率之首。经过医学界几代人数十年的不懈努力,胃癌的疗效已获得了明显的进步;但总体治愈率仍难以令人满意,死亡率居高不下一方面是与我国国民经济水平不高、大众保健意识薄弱等原因导致的早期胃癌检出率低有关另一方面也表明现有的进展期胃癌的治疗方式需要进一步改进和提高胃癌外科手术治疗规范进展期胃癌的治疗标准D2清扫扩大根治手术扩大淋巴结清扫:D3,D3+(肝十二指肠韧带,腹主动脉旁淋巴结的淸扫)联合脾脏,胰尾切除联合胰头,十二指肠切除新辅助化疗/术中腹腔内温热化疗胃癌外科手术治疗规范进展期胃癌的治疗扩大淋巴结清扫是否能提高生存率?还是仅仅提高分期特异性生存率,分期移动现象?囯内有部分研究中心支持D3/3+,广州为代表日本大部分学者支持D3D3+,尽管随机对照试验结果阴性欧洲仅怠大利部分中心支持,美国仪DO/D1D2标准根治术的必要性RCTofD2vsD2+PANDJcoG9501(07/1995-04/2001)Eligibilitycriteriaincluded:histologicallyprovenadenocarcinomaCT2b-T4,CMo,nomacroscopicmetastasistothePAN,negativelavagecytology,adequateorganfunction,andage<76LinitisplasticawasexcludedAllpatientswerefollowedwithoutadjuvanttherapyuntilrecurrenceD2+PANDJCOG9501Pvalue(n=263)(n=260)5-yrOS(%)695阌Hospmortality(%)8amamotosetal.phasellltrialofstandardDeversusD2+para-aorticlymphnode(PAN)dssection(D)forclinicallyMoadvancedgasticcanoAnnualMeetingProceedingsPartL.vol24,No.18S(June20Supplement.D2标准根治术的必要性Conclusions(JCOG95o1)D2orD2+PANdcouldbecarriedoutsafelyandshowedexcellentsurvivalforadvancedgastriccancertreatedwithcurativeintentPANDcouldnotimprovethesurvivalachievedbyd:GeneraluseofpandshouldbeavoidedsanoT.Yamamotosetal.phasellltrialofstandardDeversusD2+para-aorticlymphnode(PAN)dssection(D)forclinicallyMoadvancedgasticcanoMeetingProceedingsPartL.vol24,No18s(June20Supplement,D2标准根治术的必要性D2VSD2+PANDinourGl-SurgGroupTobepublisheddataofaCCTinSurgToday2008GISurg,WCH.SCUD2+PANDPvalue(n=62Hospmortality(%)ConclusionDSobelCaLahan胃的分区根据日本胃癌协会的标准将胃M)和下部(L)胃肿瘤根据累及不同解剖部位的程度进行描述(例如LM或UML)对于累及食管或十二指肠者则E:esophagusU:uppermiddleD:duodenum淋巴结分站No.1贲门右LNNo.13胰头后LNNo.2贲门左LNNo.3小弯LN№.15结肠中动脉固No4弯LNNa,16主动脉周国LNNo.5幽门上LNNo.17胰头前LNNo.6幽门下LNN。.18下LNNO.19扇下LNNo.8总动脉干LNNo.20食管裂孔LNNo.10胸门LNNo.