经脐小切口联合左上腹单孔腹腔镜远端胃癌根治术

首先，沿着大网膜的横结肠附着缘游离大网膜，左侧游离至脾脏下极，右侧至十二指肠降部。显露胃网膜右静脉在其根部结扎切断，完成第6v组淋巴结的清扫。显露幽门下血管和胃网膜右动脉在其根部予以结扎切断，完成第6a和6i组淋巴结的清扫。在幽门上区域开窗并离断十二指肠，根部结扎切断胃右血管蒂，完成第5组淋巴结清扫。显露并保护门静脉，在肝总动脉和肝固有动脉鞘表面清扫第8a组和12a组淋巴结。进而转向腹腔动脉根部清扫第9组淋巴结，在根部结扎并切断冠状静脉及胃左动脉，完成清扫第7组淋巴结。沿着脾动脉起始部向远心端清扫11p组淋巴结，裸化胃小弯侧，清扫第1组和第3组淋巴结。在近脾下极处显露胃网膜左血管，并于其根部结扎，清扫第4sb组淋巴结。最后，镜下完成近端残胃与空肠的Billroth II吻合及空肠间侧侧吻合。

Transumbilical single-incision plus one-port laparoscopic distal gastrectomy for advanced gastric cancer

First of all, from the lower polar of spleen to the descending duodenum, omentectomy was performed along transverse colon carefully. The right gastroepiploic vein was ligated at its root, and then No.6v lymph nodes were dissected completely. No.6a lymph nodes and No.6i lymph nodes were also dissected totally when the right gastroepiploic artery was ligated at its root. To cut the right mesogastrium at the suprapyloric area so as to transect the duodenum safely, and then No.5 lymph nodes were dissected when the right gastric artery (RGA) was ligated at its root. No.8a and No.12a lymph nodes were also dissected in en-bloc while the portal vein behind the common hepatic artery was protected safely. No.9, No.7 and No.11p lymph nodes were dissected entirely around celiac artery, left gastric artery and proximal splenic artery respectively. In addition, No. 1 and No.3 lymph nodes were dissected clearly along the lesser curvature of stomach, and No. 4sb lymph nodes were dissected when the left gastroepiploic vessels were ligated at their roots. Finally, Billroth II gastrojejunostomy and jejunojejunostomy were performed intracorporeally.