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从胃癌根治术角度浅谈胃背侧系膜近侧段的结构与功能

Structure and function of proximal segment of the dorsal mesogastrium: from the perspective of radical resection of gastric carcinoma

摘要:

100余年来,学者们一直认为网膜囊、大网膜就是胃背侧系膜,其完整切除是根治性胃癌切除术的基本组成部分。但是,网膜囊、大网膜在结构上不符合系膜的定义,临床随机对照研究结果也未能证明网膜囊切除、大网膜切除可以改善胃癌患者的预后。近年来我们提出胃背侧系膜近侧段模型,由胃右系膜、胃网膜右系膜、胃左系膜、胃网膜左系膜、胃后系膜和胃短系膜构成。胃背侧系膜近侧段的完整切除可以减少胃癌根治术中出血和淋巴结清扫中的癌泄露,从而同步改善胃癌手术的外科学效果和肿瘤学获益。胃背侧系膜近侧段模型为精准实施胃癌外科治疗提供了一个新的思路。

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abstracts:

The bursa sac and greater omentum were considered as the dorsal mesogastrium more than 100 years. Bursectomy and omentectomy has been used as an essential part of radical gastrectomy with extended lymphadenectomy. However, structure of the bursa sac and omentum were difficult to be consistent with the definition and deduction of the mesentery. Also, it was hard to be proved that bursectomy and omentectomy could get oncological benefit from clinical randomized control trials recent years. We proposed a model of the proximal segment of dorsal mesogastrium (PSDM) here to compared with bursa model. It was demonstrated that the PSDM was consisted by the right gastric mesentery, right gastroepiploic mesentery, left gastric mesentery, left gastroepiploic mesentery, posterior gastric mesentery, and short gastric mesentery. The complete PSDM excision have been proved efficient in decreasing bleeding during operation and preventing cancer leak from PSDM during lymphadenectomy, as well as limiting the surgical hazard and developing oncological benefit. So that, PSDM model was presented as an alternative model for surgeons to practice and prove, even more evidences are still on the way.

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作者: 龚建平 [1]
期刊: 《中华外科杂志》2020年58卷11期 822-825页 MEDLINEISTICPKUCSCD
栏目名称: 专家论坛
DOI: 10.3760/cma.j.cn112139-20200501-00355
发布时间: 2020-11-16
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