腹腔镜辅助全胃、胰体尾、脾脏联合脏器切除术

全麻后取倒Y体位,5孔法。进腹后探查未见广泛转移。医用胶在左肝表面喷涂,将肝脏粘在腹壁上(悬吊肝脏)。提起胃结肠韧带,超声刀分离。清扫幽门下区淋巴结。处理胃网膜右血管。分离胰腺上缘,显露肝总动脉及胃十二指肠动脉,处理胃左血管,清扫胰腺上缘及腹腔动脉淋巴结。切除小网膜直至贲门右侧,清扫区域淋巴结。分离胃大弯及脾门区淋巴结,处理胃短血管,游离食管胃连接部。分离胃胰皱襞,发现胰腺体尾部结节较硬考虑转移。决定行全胃、胰体尾、脾脏切除术。游离胰床,离断脾周韧带,超声刀削薄胰腺,直线型切割器离断,微乔间断加固。用直线型切割器离断十二指肠。上腹正中切口5cm,辅助行消化道Roux-Y重建。

Laparoscopic assisted Total Gastrectomy,Distal Pancreatectomy and Splenectomy

Under general anesthesia , patient lied on operating table in inverted Y position .Five trocars were placed and laparoscope was introduced in the abdomen , left liver was elevated on the abdominal wall by chemical glue .Gastrocolic ligament was divided using Ultrocision .Lymph nodes were harvested in the pylorus area , right gastroepiploic vessels were ligated .Then common hepatic artery and gastroduodenal artery , left gastric blood vessels were isolated and the lymph nodes were dissected too .Lesser omentum and regional lymph nodes were dissected. Management along with greater curvature , splenic hilum and left side of the Gastroesophageal conjunction.Blood vessels were clipped and transected lymph nodes were dissected .So we decided to perform combined multiple organ resection .Pancreatic bed and spleen ligaments was dissected and pancreas was transected by liner cutter .Finally duodenum was transected by liner cutter and assisted upper abdominal midline incision of 5 cm was made to complete Roux-en-Y alimentary tract reconstruction .