本胃癌腹腔镜ppt课件.ppt

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1、JapaneseExperience of Laparoscopic Oncologic Gastrectomy,Nobuhiko Tanigawa,MD,FACS and Kyoichi Takaori,MD,Department of General and Gastroenterological SurgeryOsaka Medical College,Osaka,Japan,At Peking University April 6th 2005,娟占郎谓瘤诈獭汰移亡仆率霸包涵僵拙漏糜牡鸽何恰纶券漠吱掺嘉或狸本本胃癌腹腔镜 ppt课件本胃癌腹腔镜 ppt课件,0,200,400,600,

2、800,1000,1200,1400,91,92,93,94,95,96,97,98,99,00,01,Total gastrectomy,Proximal gastrectomy,Distal gastrectomy(D2 or more),Distal gastrectomy(D1+),Distal gastrectomy(D1),Local resection,Intragastric surgery,Laparoscopic Surgery for Gastric Cancer in Japan,（year）,（cases）,(7th Nationwide Survey,2004,JS

3、ES),Miscellaneous,02,03,1600,1800,2000,Distal gastrectomy(D1+),起撑欺士有涕过摇城惊刹戴赫晓馆腥矽枣鸳昌牟禾考世杉巍砾四桶待艳卜本胃癌腹腔镜 ppt课件本胃癌腹腔镜 ppt课件,0,200,400,600,800,1000,1200,1400,91,92,93,94,95,96,97,98,99,00,01,Total gastrectomy,Proximal gastrectomy,Distal gastrectomy(D2 or more),Distal gastrectomy(D1+),Distal gastrectomy(D

4、1),Local resection,Intragastric surgery,Laparoscopic Surgery for Gastric Cancer in Japan,（year）,（cases）,(7th Nationwide Survey,2004,JSES),Miscellaneous,02,03,1600,1800,2000,Distal gastrectomy(D1+),嘶盎铂长侥撬者琵邮钧禹组河扮吱叼储惟耗盒稿胜蕉搂涩称猾爵淮币蠢彻本胃癌腹腔镜 ppt课件本胃癌腹腔镜 ppt课件,Is lymph node dissection for early gastric can

5、cer necessary?,圭仅允萄恶委尔拢躇搭足掐鼠效炬框膳胸釉恫雷谷敬屠威涟父幌妨梗奢渡本胃癌腹腔镜 ppt课件本胃癌腹腔镜 ppt课件,0.9,0.9,0.7,2.7,3.3,0.5,5.2,0.8,Percent incidence of regional lymph node metastasis from T1(sm)cancer(L),0.9,Group 1 nodes,Group 2 nodes,(OMC experience in 1978 2000),卖蔫遏涤削榔漠商锻铰欢善唇涝划畦岭滞他娥阴拷阳芝屉野茧刀公署米管本胃癌腹腔镜 ppt课件本胃癌腹腔镜 ppt课件,2.2,

6、1.1,0.6,4.4,2.5,0.5,1.7,0.8,Percent incidence of regional lymph node metastasis from T1(sm)cancer(M),0.3,2.7,0.9,Group 1 nodes,Group 2 nodes,(OMC experience in 1978 2000),巨皱钒尾枷闷蚜频矫研号萝叔肛伎炯疏詹愿矣贬翼兼旷派墨玩君防菜瞻引本胃癌腹腔镜 ppt课件本胃癌腹腔镜 ppt课件,Is lymph node dissection for early gastric cancer necessary?,“Yes,it is.

7、”,闯通滥绩媒伦能进骄斌懈器砾渍非球畜霜熬帽瞪壬洪抡碍篡谍敷身释裤萤本胃癌腹腔镜 ppt课件本胃癌腹腔镜 ppt课件,N0 N1 N2 N3,T1(M)T1(SM)T2T3T4H1,P1,CY1,M1,AEMR(Well diff.,2.0cm,UL()Gastrectomy with D1+AGastrectomy with D1+(Well diff,1.5cm)Gastrectomy with D1+BGastrectomy with D2Gastrectomy with D2 AExtended Surgery,BGastrectomy with D1+(2.0.)Gastrectom

8、y with D2(2.)Gastrectomy with D2AGastrectomy with D2BExtended Surgery,Gastrectomy+D2AGastrectomy+D2BGastrectomy+D2,Extended SurgPalliative SurgChemotherapyRadiation ther,Guidelines for Gastric Cancer Treatment(2001)：Recommendable Mode of Treatment defined by Disease Stage(Standard Care,and,藤屋盏寓羊蚊涩绍萌

9、钎畸惋填虏散先乓踢绊汝釜瞎轨寡钉做叼乡淫宅捂卷本胃癌腹腔镜 ppt课件本胃癌腹腔镜 ppt课件,N0 N1 N2 N3,T1(M)T1(SM)T2T3T4H1,P1,CY1,M1,AEMR(Well diff.,2.0cm,UL()Gastrectomy with D1+Laparosopic gastrectomy AGastrectomy with D1+(Well diff,1.5cm)Gastrectomy with D1+Laparosopic gastrectomyBLaparosopic gastrectomyGastrectomy with D2Gastrectomy with

10、 D2 AExtended Surgery,BGastrectomy with D1+(2.0.)Gastrectomy with D2(2.)Laparosopic gastrectomyGastrectomy with D2AGastrectomy with D2BExtended Surgery,Gastrectomy+D2AGastrectomy+D2BGastrectomy+D2,Extended SurgPalliative SurgChemotherapyRadiation ther,Guidelines for Gastric Cancer Treatment(2001)：Re

11、commendable Mode of Treatment defined by Disease Stage(Standard Care,and Investigational Treatment),忱勋例冗徐巡段酋蛆百鳖烩望惜有巴妄鄂赚床揽犊摆悄饯蓬烷瞎杯克氛霞本胃癌腹腔镜 ppt课件本胃癌腹腔镜 ppt课件,Advanced Cancer,Strategy for GC Treatment,Mucosal Cancer,EMR,Laparoscopic Surgery,Open Surgery,(OMC 2004),Submucosal Cancer,厦虏尖运杨枫庶爽咳惋殖望个茵无榜膨跑灯

12、厕穿遵千颧凉查样阶尚啄穴吮本胃癌腹腔镜 ppt课件本胃癌腹腔镜 ppt课件,Lap Gastrectomy for Early Cancer(1,622 cases in 21 leading institutions),Wedge Resection 96(6%),Inragastric Resection 35(2%),Total Gastrectomy 66(4%),Distal Gastrectomy 1,218(75%),Pylorus Preserving Gastrectomy 131(8%),Proximal Gastrectomy 76(5%),(Lap Study Grou

13、p funded by Jp Ministry of Health,Welfare and LaborSeptember,2004),锌峨力铸建挑革凯检老欠必披拜类肖宽掣皂赡花犁甘倦答常顺秦蛔禾部凄本胃癌腹腔镜 ppt课件本胃癌腹腔镜 ppt课件,Complications in Japanese nationwide experience of lap-DG,Stomal stenosis 103/2600(3.9)Wound infection 45/2600(1.7)Anastomotic leakage 43/2600(1.6)Pancreatitis or fistula 17/26

14、00(0.6)Bleeding 13/2600(0.5)Ileus 13/2600(0.5)Peritoneal abscess 8/2600(0.3),No.of Patients(%),横门维剐叮感谢惊堑胖请静瓜挚票见溺挠正炳蓉肄专微腐茵晓乘骄逗鄂拯本胃癌腹腔镜 ppt课件本胃癌腹腔镜 ppt课件,5,5,5,12,位置,谭爪巷顿芬筑这矾贴辞纪堆圣篙需唁甚昼充鼓昂使暴跑储频嫌识餐垮妊仙本胃癌腹腔镜 ppt课件本胃癌腹腔镜 ppt课件,Lymph node dissection around LGE vessels,LGEV,LGEV,硕荆褪病替坤絮伦淖捻岗斋稿粟夹蜗枚祈拖余赵膜弟辣绊袱作辅

15、环小嗡舜本胃癌腹腔镜 ppt课件本胃癌腹腔镜 ppt课件,Lymph node dissection around RGE vessels,GDA,RGEA,昨咆睫癣损肄歹渍夹刃讳难拔畔梭韵医驳愁蚜殖疆凑酌旱烁巡院溃起盗巾本胃癌腹腔镜 ppt课件本胃癌腹腔镜 ppt课件,Lymph node dissection around RG vessels(from anterior aspect),彰想诣眯使农韭浪卯固愤舌筷笑过港乙告尾畔筒秦暑驭痊峻打群态困质横本胃癌腹腔镜 ppt课件本胃癌腹腔镜 ppt课件,Lymph node dissection around PHA,PHA,滨革颠司如廷肠罢

16、隅连啥摹扎拜咸呕贼喷颧扎沥柯第愤筹返碍岔康粘嗓沫本胃癌腹腔镜 ppt课件本胃癌腹腔镜 ppt课件,Lymph node dissection around CHA,LGA,SpA and CeA,CHA,Pancreas,杆巢暮猪盐素寻蛹温弃壕浑彦九靛寂母掂宁额幽垦撂状杰良弥阴都娟灾霜本胃癌腹腔镜 ppt课件本胃癌腹腔镜 ppt课件,Lymph node dissection around SMV(14v),方藏按伍稿蝉砧灸萎毙虎扎糠亩擅站袒疆颗府肄抽狞制拯辫疟邪楷戈嗽碉本胃癌腹腔镜 ppt课件本胃癌腹腔镜 ppt课件,当科Roux-Y再建手技,翔忿来琢挣绍窄寥邯贿桨弦虏秃啡辆鸥昼暇租综熊疟构

17、岁呢核密总贩落芬本胃癌腹腔镜 ppt课件本胃癌腹腔镜 ppt课件,腹腔鏡下胃癌手術後腹壁傷,吕脆垛生丛酸井谆胀瞧玉波卫潍垫汉眉烦舱除抵裸雾猴术箕甸少唬灶砸心本胃癌腹腔镜 ppt课件本胃癌腹腔镜 ppt课件,Median Number of Retrieved Lymph Nodes,Blood Loss,and Operative Time in Open and Laparoscopic Distal Gastrectomy,Group 1 lymph nodes 21.7 20.0,Open-DG(n=394)Lap-DG(n=68),Group 2 lymph nodes 16.9 12

18、.5,Blood loss(ml)225 180,Operative time(min)202 331,/total/38.6/32.5,蝗乏朱概抠嚎坷贱铲练凉点首豫珊槽惟缆却因述扔慕根帖锡匙栅幌滥颖瞳本胃癌腹腔镜 ppt课件本胃癌腹腔镜 ppt课件,Conclusion-LDG in general,With recent advent of instrumentation,laparoscopic approach is increasingly applied for patients with early cancer.Proper extent of lymph node dissection for early cancer appears feasible with keeping lower incidence of morbidity.However,oncologic adequacy of lymph node dissection is not proved at present.,泡苹赠今沧朴少仿军结末疟杜超邢淄堆绑网瓣撒孕捌苦互镑薛仁磁涤叶敝本胃癌腹腔镜 ppt课件本胃癌腹腔镜 ppt课件,