腹腔镜Nissen胃底折叠术联合胃大弯袖状切除术

手术要点：距幽门3—5cm处起,以超声刀贴胃壁分离大网膜,向上至贲门左侧His角。打开胃小弯上部小网膜,剔除贲门前肥厚脂肪垫,游离两侧膈肌脚根部,游离腹段食管,修补扩大的食管裂孔2—3针。胃镜引导下,用腔镜专用直线切割闭合器沿胃大弯侧距幽门4～6cm处开始向胃底方向连续切割闭合,鱼鳍状保留胃底,切除胃大弯侧3／5。残胃腔内胃镜注气,胃切缘外喷水检查有无漏气,以除外胃切缘漏。两个相邻钉仓切缘间以及有出血处以3-0可吸收线缝合加固。牵拉保留的胃底从食管后方绕过行改良Nissen法折叠,即将绕过食管后方的左侧胃底与右侧胃底前壁缝合2～3针,完成食管周围的360°折叠,并将胃底缝合固定于右侧膈肌脚2～3针。

Laparoscopic Nissen fundoplication and sleeve resection of gastric antrum

Laparoscopic Nissen fundophcation combined with the greater curvature of the stomach sleeve resection is the treatment of severe obesity and gastroesophageal reflux disease. It is done from helicobacter 3 -5 cm, by an ultrasonic knife separating the greater omentum up to the left His angle of the cardia. The lesser curvature of the stomach is opened to dissect cardiac hypertrophic fat, while mobiling the bilateral diaphragmatic foot root, dissecting abdominal esophagus, esophageal hiatalrepair expanding 2 - 3 sutures. Guided by a gastroscope, direction of continuous cutting was made toward the gastric bottom with endoscopic special staplers along the greater curvature of the stomach with retained gastric bottom. Approximately, 3/5 of the gastric greater curvature was resected. Gastroscope gas injection and gastric resection margin were examined to check whether there is no leakage, except for stomach incision leakage. Two adjacent cartridge margins and bleeding were fixed by 3 -0 absorbable suture. The retention of gastric esophageal bypass line was pulled with the modified Nissen folding method. The esophageal gastric fundus was bypassed near the left and right gastric fundus with 2 - 3 sutures.