中国实用外科杂志

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胃上部癌术中保证胃系膜完整性的意义和精细解剖要点

杜晓辉,梁文全,李宇轩   

  1. 中国人民解放军总医院第一医学中心普通外科医学部,北京 100853
  • 出版日期:2025-07-01

  • Online:2025-07-01

摘要: 随着微创技术进步,膜解剖理念推动胃癌手术向完整系膜切除方向发展。胃上部癌因解剖位置特殊(毗邻贲门、食管及膈肌),手术难度大、并发症多,治疗策略存在争议。实现胃左血管系膜、脾血管系膜及左膈下动脉系膜等关键区域的完整性切除,是提升疗效的核心前提。通过引入“完整系膜切除”的手术策略,结合膜间层面的清晰分离与血管导向的操作原则,可有效减少术中癌细胞外溢、降低术后并发症发生率,提升淋巴清扫的彻底性与手术安全性。

关键词: 胃上部癌, 系膜完整性, 膜解剖, 完整系膜切除

Abstract: With the advancement of minimally invasive techniques, the concept of membrane anatomy has propelled gastric cancer surgery toward the goal of complete mesenteric excision. Due to its unique anatomical location (adjacent to the cardia, esophagus, and diaphragm), upper gastric cancer presents significant surgical challenges, high complication rates, and ongoing controversies in treatment strategies. Ensuring the integrity of key mesenteric structures, such as the left gastric vascular mesentery, splenic vascular mesentery, and left inferior phrenic artery mesentery, constitutes the core prerequisite for improving therapeutic efficacy. By implementing the surgical strategy of “complete mesenteric excision”, combined with precise dissection along interfascial planes and vascular-guided operative principles, this approach effectively reduces intraoperative cancer cell spillage, decreases postoperative complication rates, and enhances the thoroughness of lymph node dissection alongside surgical safety. 

Key words: upper gastric cancer, mesogastric integrity, membrane anatomy, complete mesenteric excision