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1、MinimallyInvasiveTherapy.2010;19:355–363ORIGINALARTICLEAneworderofD2lymphadenectomyinlaparoscopicgastrectomyforcancer:Liveanatomy-baseddissectionGUO-XINLI,CEZHANG,JIANGYU,YA-NANWANG,YAN-FENGHUDepartmentofGeneralSurgery,NanfangHospital,SouthernMedicalUniversity,Guangzhou
2、,Guangdong,ChinaAbstractItwastheaimofthisstudytodevelopamethodologyfordissectioninlaparoscopicdistalgastrectomywithD2lymphadenectomy(D2LDG)forgastriccancer.One-hundredandthirty-twopatientswithdistalgastriccancerunderwentD2LDGwithanovelsequenceoflymphnodedissectionbetwee
3、nAugust2004andJune2008.Liveanatomyineachstepwasobservedsimultaneouslytoensureandconfirmthenewlydevelopedmethodology.DissectionsinLDGwerestandardizedassequentialsteps:Dividingthegastrocolicligamentandgettingaccesstotheprepancreaticspace–lymphnodedissectioninthelowerleftar
4、ea–lymphnodedissectioninthelowerrightarea–lymphnodedissectionintheupperrightarea–lymphnodesdissectioncentrally–lymphnodedissectionbetweenliverandstomach.Alldissectionsweresuccessfullyperformedinperipancreaticspacesandtheirextensions.Gastricvesselswerelocatedbyspeciallan
5、dmarks,tracedalongvasculartrunksandbifurcations,andidentifiedbyfinedissectiontechniqueinvaginavasorum.SequentialdissectionaroundthepancreaswasaneffectivemethodforD2LDG.Itwasensuredbyanatomicalknowledgeineachstep:Vesselsandfascialspacesaroundacentrallandmark,thepancreas.Ke
6、ywords:Minimallyinvasivesurgery,laparoscopicgastricsugery,gastriccancer,anatomyIntroductionstudybetweenAugust2004andJune2008.PatientsdiagnosedwithgastriccanceratmiddleandlowerEnblocresectionofthemesogastriumanddissectionthirdpartatstageII-IIIB(cT2N0M0-cT3N2M0)ofperigast
7、riclymphnodes(LNs)areoncologicalaccordingtoendoscopicandimagingfindingsindemandsinlaparoscopicdistalgastrectomy(LDG)ourhospitalwereeligible.EachpatientsignedwithD2lymphadenectomyforgastriccancer(1).Dueinformedconsentbeforeundergoinglaparoscopictocomplexembryologicalproce
8、sses,theperigastricdistalgastrectomy(LDG)withD2lymphadenect-structuresdistributearoundthepancreas(2).Theomy.Th
