全腹腔镜根治性全胃切除术

34岁女性胃体腺癌患者，拟行全腹腔镜根治性全胃切除术。患者取平仰卧位，主刀位于患者左侧。腹腔镜下探查肿瘤位于胃体，无腹腔种植转移。游离大网膜及横结肠系膜前叶，向左达脾下极，向右达结肠肝曲。继续游离、夹闭、离断胃左右动静脉、胃网膜左右动静脉、胃短动脉、胃后动脉，清扫NO.1～NO.11，NO.12a，NO.12p，NO.14v组淋巴结。幽门远端3 cm离断十二指肠。腔镜下游离小肠系膜，距屈氏韧带20cm处切割闭合离断空肠，远端上提，使用overlap技术完成食道空肠的侧侧吻合，连续缝合关闭共同开口。据此吻合口远端40 cm处行近端空肠远端空肠的侧侧吻合，连续缝合关闭共同开口。检查吻合口对合良好。冲洗术野，腹腔镜下放置腹腔引流管。

Totally laparoscopic radical total gastrectomy

A 34 year old female patient with gastric adenocarcinoma underwent totally laparoscopic radical total gastrectomy. The supine position was prepared and the surgeon stood on left side of patient. Laparoscopic exploration showed that tumor located at gastric body, without peritoneal metastasis. The reaterg omentum and the anterior lobe of transverse mesocolon was divided from hepatic flexure to inferior splenic pole. The right and left gastric vessels, the right and left gastroepiploic vessels, the short gastric arteries as well as the posterior gastric artery were dissected and cutted at the root, with the clearance of No.1~No.11, No.12a, No.12p and No.14v lymph nodes. The duodenum was transected 3 cm distal to the pylorus. The mesentery of small intestine was dissected and the jejunum was transected 20cm distal to the Treitz ligament by using Endo-GIA. Side-to-side anastomosis of esophagus and jejunum was performed by using overlap technique. The joint incision was closed by continuous suture. A side-to-side anastomosis between the proximal and distal jejunum was performed 40cm distal to the esophagus-jejunum anastomosis, and the joint incision was closed by continuous suture. Abdominal drainage tubes were placed after the surgical field was completely rinsed.