Anatomy and influence of the splenic artery in laparoscopic spleen-preserving splenic lymphadenectomy

作者：Zheng, Chao-Hui; Xu, Mu; Huang, Chang-Ming^*; Li, Ping; Xie, Jian-Wei; Wang, Jia-Bin; Lin, Jian-Xian; Lu, Jun; Chen, Qi-Yue; Cao, Long-Long; Lin, Mi

来源：World Journal of Gastroenterology, 2015, 21(27): 8389-8397.

DOI：10.3748/wjg.v21.i27.8389

• Stomach neoplasms
• Spleen-preservation
• Laparoscopy
• Lymphadenectomy
• Vascular anatomy

AIM: To investigate the splenic hilar vascular anatomy and the influence of splenic artery (SpA) type in laparoscopic total gastrectomy with spleen-preserving splenic lymphadenectomy (LTGSPL).
METHODS: The clinical anatomy data of 317 patients with upper- or middle-third gastric cancer who underwent LTGSPL in our hospital from January 2011 to December 2013 were collected. The patients were divided into two groups (concentrated group vs distributed group) according to the distance between the splenic artery's furcation and the splenic hilar region. Then, the anatomical layout, clinicopathologic characteristics, intraoperative variables, and postoperative variables were compared between the two groups.
RESULTS: There were 205 patients with a concentrated type (64.7%) and 112 patients with a distributed type (35.3%) SpA. There were 22 patients (6.9%) with a single branch of the splenic lobar vessels, 250 (78.9%) with 2 branches, 43 (13.6%) with 3 branches, and 2 patients (0.6%) with multiple branches. Eighty seven patients (27.4%) had type I splenic artery trunk, 211 (66.6%) had type II, 13 (4.1%) had type III, and 6 (1.9%) had type IV. The mean splenic hilar lymphadenectomy time (23.15 +/- 8.02 vs 26.21 +/- 8.84 min; P = 0.002), mean blood loss resulting from splenic hilar lymphadenectomy (14.78 +/- 11.09 vs 17.37 +/- 10.62 mL; P = 0.044), and number of vascular clamps used at the splenic hilum (9.64 +/- 2.88 vs 10.40 +/- 3.57; P = 0.040) were significantly lower in the concentrated group than in the distributed group. However, the mean total surgical time, mean total blood loss, and the mean number of harvested splenic hilar lymph nodes were similar in both groups (P > 0.05 for each comparison). There were also no significant differences in clinicopathological and postoperative characteristics between the groups (P > 0.05).
CONCLUSION: It is of value for surgeons to know the splenic hilar vascular anatomy when performing LTGSPL. Patients with concentrated type SpA may be optimal patients for training new surgeons.

• 出版日期2015-7-21
• 单位福建医科大学