完全腹腔镜远端胃癌根治术

患者全身麻醉,5孔法建立气腹。探查:无腹水,胃壁未见肿瘤外侵,胃周淋巴结稍肿大,未见腹盆腔种植转移,行完全腹腔镜下根治性远端胃大部分切除术(D2淋巴结清扫,毕II式+Braun吻合)。手术路线:切开肝胃韧带,沿右侧膈角表面打开,显露贲门右侧;打开胃结肠韧带,进入胃、结肠系膜融合间隙,游离并离断胃网膜右血管,清扫No.6组淋巴结;离断十二指肠;清扫胰腺上区淋巴结,顺序是:No.5、12a、8a、11p、7、9;随后清扫No.1、3、4sb、4d组淋巴结;离断远端胃,标本于脐周约3.5 cm小切口取出;取屈氏韧带以远40 cm处空肠,与残胃行侧侧吻合(毕II式吻合),距胃肠吻合口25 cm处,行输入袢、输出袢侧侧吻合(Braun吻合)。所有操作均在腹腔镜下完成。

Total laparoscopic radical distal gastrectomy

After general anesthesia,established pneumoperitoneum with 5-hole method.Exploration:no ascites,no serosa invasion of the stomach,perigastric lymph nodes slightly swollen,no peritoneal metastasis.Complete laparoscopic radical distal gastrectomy(D2 lymph node dissection,Billroth II with Braun anastomosis)was performed.Surgical route:opened the hepatogastric ligament,and the right side of cardia along the surface of the right diaphragmatic angle;opened the gastrocolic ligament,entered the fusion space,cutted the right gastro-omental vessels,cleaning No.6 lymph nodes;After dissection of duodenum,cleaned the lymph nodes above pancreas,successively:No.5,12a,8a,11p,7,9;then No.1,3,4sb,4d;And then cutted off distal stomach,the specimen was taken out from a 3.5cm incision around the umbilicus;Took the jejunum 40cm from the Treize's ligament,and the remnant stomach to do side to side anastomosis(BiIIroth II anastomosis),then did side to side anastomosis(Braun anastomosis)between afferent loop and output loops,25cm away from the Billroth II anastomosis.All procedures were done laparoscopically.