Gastric carcinoma radically treats the basic _'s treatment of skill anatomy

Gastric carcinoma radically treats the basic _'s treatment of skill anatomy
Aim at making the radical cure skill that the patient is cured ought to include: 1, The part or excising completely of organ having illness coming on in the cooking stove originally, cutting the end must be guaranteed negatively; 2,It is it possible quilt tumour stomach to clean completely and regionality and lymph nodes at a distance relevant. In brief, should excise the range the wide leeway is greater than the range that tumour involves. Just as moon well known, in all cancerous swelling including gastric carcinoma, the giving much trouble of lymph node will influence the cure rate directly or not. But the amount of time of correlative of survival rate of five years that negative and positive cases of lymph node are their own. However, the regional lymph node takes place to shift in 12.4-30.0% of the cases even in gastric carcinoma in early days, in developing issues of gastric carcinoma, overall the intersection of lymph node and above the 80% person who shift of patient. So, it is one of the keys which improves the operation curative effect of gastric carcinoma to deal with effectively and is given much trouble the lymph node. In addition, during operation, should also carry out " have no tumour " hard Operate law sum " Monoblock is excised " Wait for the basic principle of tumour and surgery.
In order to further know, and can be used to guide concretely all alone the skill is operated, should prove from anatomy and respects such as anatomy of embryo of the upper abdomen viscera,etc. related to gastric carcinoma operation.
First, the subregion of the stomach and lymph node related to gastric carcinoma divide into groups in and the substation
To facilitate e into groups carrying on the lecture and planning to introduce the stomach subregion law that the research association of Japan's gastric carcinoma makes and lymph node related to gastric carcinoma to divide into groups ing briefly first by way of unifying, substation law.
Divide greater curvature and lesser curvature into three in equal division respectively. Connect three subregions where it gets the stomach after clicking correspondingly, they are: The top, middle part and underpart cancer soak the persons who are only limited to a district, represent it with C, M or A. If involving two or three districts, write the main subregion first, and then write the subregion soaked, such as such as MC, AM, MCAD,etc.. If upper cancer prolongs and esophagus, cancer in the underpart is soaked to the duodenum, represent with CE, AD respectively.
The lymph node related to gastric carcinoma can be divided into 18 groups, they are: 1, Right lymph node of cardia; 2,Lymph node after the left of cardia; 3,Small curved lymph node; 4,Big curved lymph node; 5,Lymph node on the pylorus; 6,Lymph node under the pylorus; 7,Stomach left artery be lymph node; 8,Liver total artery be lymph node; 9,Lymph node around the arteria coeliaca; 10,Spleen door lymph node; 11 the intersection of spleen and artery be lymph node; 12,Lymph node in liver, duodenum ligament; 13,Lymph node behind the pancreas; 14,Mesenterium root lymph node; 15,Lymph node around the artery in colon; 16,Lymph node around the belly aorta; 17,Lymph node by the esophagus under the chest; 18,Diaphragm lymph node.
Second, anatomy of embryo of the upper abdomen viscera related to gastric carcinoma operation
Overall arrangement of internal organs of upper abdomen before rotating. Rotate, the intersection of back and the intersection of side and the intersection of department and the intersection of membrane and the intersection of membrane and wall affix to, of stomach, carry the intersection of side and mesogastrium, pregnant with the intersection of pancreas and the intersection of body and tail and spleen. But is fixed by the side mesogastrium of belly in the front of the stomach, the latter is divided into sickle ligament and small omentum by the liver. Similarly, the spleen will carry the mesogastrium of side to divide into ligament of spleen of stomach and spleen kidney ligament.
At the time of the operation, if want to free spleen and pancreas body end, can separate along this dotted line, make it recover to a state of embryo than being damage main blood vessel and other organization any not to carry the mesogastrium of side.
After the internal organs are rotated, pancreas head and pancreas body tail regard blood vessel on the mesenterium as the axis to close up. While growing up, can still observe the trace of different development sources between the two, if each one's own exocrinosity tutor is in charge of supporting etc. with the arterial blood.
View, liver, stomach, pancreas and spleen therefore according to embryo anatomy is from before there extend is intestines, and the parcel is in tying the membrane the samely. , but their lymphocytic drainage still can't be linked together separating.
So, while making gastric carcinoma and expanding and radically treating the skill, cut off the pancreas on pancreas head and pancreas body intersection correctly, and the intersection of body and tail and stomach act as monoblock, excise together not only accords with embryo's anatomy concept spleen and pancreas, and can guarantee the lymph node of the 10th, 0.55th kilogram of groups is done together with whole operation sample " Monoblock " Remove completely.


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