The Clinical Significance Of Using Small Incision In Advance To Assist Around The Pylorus Lymph Node Dissection In The Laparoscopic Radical Gastrectomy

Objective laparoscopy-assisted distal gastrectomy(LADG)is one of the most widely performed distal radical gastrectomy in the country.The minimally invasive assisted digestive tract reconstruction method has been widely recognized by surgeons,but due to the inferior pyloric region Due to various anatomic variations and difficulty in exposure of the pancreas in the upper pancreatic tissue,lymph node dissection in the NO.6,NO.14 v,NO.8,and NO.12 a has always been the difficulty in laparoscopic lymph node dissection,and the distribution of lymph nodes in the pyloric area and upper pancreas is also Patients with distal gastric cancer D2 radical resection were mainly cleaned up.So why not try to make a small incision in advance under the xiphoid process,make full use of the small incision originally used for digestive tract reconstruction,and assist the pyloric lymph nodes through a small incision(ie,pyloric area NO.5,NO.6,NO.14 v lymph nodes and the upper pancreas NO.8a,NO.12 a,and NO.4d lymph nodes)were dissected.Laparoscope cleanup of the remaining lymph nodes was then performed.Finally,a small incision was used again to assist the reconstruction of the digestive tract.To investigate(pre-small incision laparoscopy-assisted distal gastrectomy PLADG)the small incisionassisted in the pyloric area and supra pancreatic area NO.8,NO.12 a and NO.4d Significance of lymph node dissection.Methods This is a retrospective analyzing in which the clinical data of 156 patients with distal gastric cancer admitted from July 2015 to February 2018 in Sichuan Provincial People's Hospital.According to the different methods of distal gastric cancer D2 radical resection,patients were divided into three groups.Cases,50 patients with PLADG,46 patients with LADG and 60 patients with open distal gastrectomy(ODG).The clinical data of each group were retrospectively analyzed.General information such as gender,age,BMI,preoperative ASA grading,preoperative complications,TNM staging,anastomosis methods,and tumor diameter for each group of patients.incision length,intraoperative blood loss,Operative time,CO2 pneumoperitoneum maintenance time,total number of lymph node dissection,the number,the time and the amount of blood loss for lymph node dissection of NO.4d,NO.5,NO.6,NO.8,NO.12 a,NO.14 v,the lymph node metastasis rate for NO.4d,NO.5,NO.6,NO.8,NO.12 a,NO.14 v,first postoperative anus exhaust time,ambulation time,postoperative hospital stay,postoperative Complications and other data were analyzed statistically,to observe the significance of lymph node dissection with PLADG small incision assisted in the pylorus and pancreas NO.8,NO.12 a,and NO.4d.Results There was no significant difference in general data such as age,BMI,preoperative anesthetic ASA classification,preoperative complications,TNM staging,anastomosis methods,and tumor diameter between the three groups(P>0.05),and they were comparable.The incision length,intraoperative blood loss,first postoperative anus exhaust time,ambulation time,postoperative hospital stay in the PLADG group were all less than those in the ODG group(P<0.05).total number of lymph node dissection,the number of lymph node dissection for NO.4d,NO.5,NO.6,NO.8,NO.12 a,NO.14 vgroups,the lymph node metastasis rate for NO.4d,NO.5,NO.6,NO.8,NO.12 a,NO.14 v groups,The difference was not statistically significant(P>0.05);In the PLADG group,operative time,the time and the amount of blood loss for lymph node dissection of NO.4d,NO.5,NO.6,NO.8a,NO.12 a,NO.14 v groups,CO2 pneumoperitoneum maintenance time,were shorter than that in the LADG group.There was statistical significance(P<0.05);incision length,intraoperative blood loss,the number of lymph node dissection and the lymph node metastasis ratefor NO.4d,NO.5,NO.6,NO.8,NO.12 a,NO.14 vgroups,first postoperative anus exhaust time,ambulation time,postoperative hospital stay,The difference was not statistically significant(P>0.05).There was no significant difference in the incidence of postoperative complications between the three groups(P>0.05).Conclusions 1)Pre-assisted small incision around the pylorus lymph node dissection is consistent with radical surgical treatment of distal gastric cancer.2)PLADG pre-assisted small incision in the implementation of distal radical gastrectomy is safe,feasible,shorter than the LADG operation time,less pyloric lymph node dissection time and less bleeding,similar incidence of postoperative complications,but in patients with BMI ?25kg/m2 the clinical significance is not significant,and the long-term efficacy needs further study.3)The PLADG small incision assisted lymph node dissection and reconstruction of the digestive tract do not add additional learning burden to endoscopic surgeons who have rich experience in ODG surgery.They are highly practical for primary surgeons and endoscopes in primary hospitals and perform full laparoscopic surgery.Transitional learning has important clinical implications.