腹腔镜远端胃癌D2根治术中常见的出血部位和原因及其处理对策

Common causes and management strategies for intra-operative bleeding during radical laparoscopic distal ;gastrectomy with D2 lymph node dissection

术中出血是腹腔镜远端胃癌 D2根治术开展初期的一大难题。笔者结合广州南方医科大学南方医院普通外科多年来开展腹腔镜胃癌手术的经验和体会，针对该术式过程中可能出血的部位、原因及处理策略进行逐一分析，并提出：保持良好的显露、遵循正确的层面、进行精细的解剖、合理使用能量器械以及小心提防各种血管变异，是防治术中出血的重要策略。

Intraoperative bleeding is a major challenge for performing radical laparoscopic distal gastrectomy with D2 lymphadenectomy. We summarize our experience in laparoscopic surgery from the Department of General Surgery , at Nanfang Hospital of Southern Medical University. We believe that good exposure of the surgical field , following the correct surgical plane, accuratedissection of perigastric structures, proper usage of energy equipment, and awareness of possible vascular variations were key strategies for dealing with intraoperative bleeding.