腹腔镜远端胃癌切除胃空肠Uncut Roux-en-Y吻合术

远端胃切除和淋巴结清扫结束后,进行腹腔镜消化道重建。首先提起横结肠,寻及Treiz韧带,提起距之约25 cm处的空肠,经系膜无血管区带线标记并待提出。沿观察孔切口绕脐向上延切口长约3~4 cm,自此切口取出标本。将标记小肠牵引线连同近端空肠自切口拖出,确认远近端后,距牵引线标记近端8 cm与远端40 cm处空肠行侧侧吻合,于标记线处用闭合器(无刀片)闭合肠管但不予以切断。最后将肠管还入腹腔,关闭腹部切口后,重新建立气腹。在闭合处远端2 cm使用直线切割缝合器行空肠残胃侧侧吻合,并关闭共同开口。

Laparoscopic distal gastrectomy for gastric cancer by uncut Roux-en-Y anastomosis

After distal gastrectomy and D2 lymph node dissection, laparoscopic gastrointestinal reconstruction was performed.Firstly, the transverse colon was retracted cephalad to expose Treitz ligament , and the jejunum that 25 cm distal to Treitz ligament was labeled to be pulled out .Secondly, a 3-4 cm upward incision was made around umbilicus, through which the specimen was harvested and the surgical margins were confirmed.The proximal 8 cm and distal 40 cm to the labeled site of the jejunum, a side to side J-Jstomy was performed.The afferent jejunal loop was blocked by a stapler without blade.Then we returned small bowels back into abdominal cavity.Lastly, after closure of abdominal incision and establishment of pneumoperitoneum, a gastrojejunostomy was performed by an endo-linear stapler at the site of proximal 2 cm to the blocking site on the afferent limb.The common incision of gastric and jejunum was closed by another endo-linear stapler.