腹腔镜全胃切除术

Laparoscopic total gastrectomy for gastric cancer

尽管技术手段不断改良更新,腹腔镜全胃切除术中的腔内食管空肠Roux-en-Y吻合仍然在技术上充满挑战,成为制约其发展的瓶颈之一.据此,我们团队利用“一体化捆绑技术”使用经口抵钉座置入系统改进了这一过程.本文视频展示了1例胃多原发腺癌病例：贲门]（T1）和胃窦（T2）各见一病灶,仅小弯侧幽门周围见1枚可疑淋巴结肿大,未见转移征象.一般地,我中心对于近端胃局部进展期癌常规行No.10组淋巴结清扫,但本例贲门 处为早期病变,故行腹腔镜全胃切除、D2-No.10淋巴结清扫术.

Although several methods have been introduced,intracorporeal Roux-en-Y esophagojejunostomy during laparoscopic total gastrectomy for gastric cancer remains a challenge.We modified this procedure （integrated binding technique） based on a surgical string fixing technique by using a transorally inserted anvil （OrVilTM; Covidien）.The attached video introduced a case of multicentric primary gastric adenocarcinoma：one lesion located in the cardia （T1-staging） and the other in the antrum of the stomach （T2-staging） with only one suspiciously involved lymph node（LN） near the pylorus along the lesser curvature and without distant metastasis.Generally,No.10 LN dissection is a routine procedure for advanced proximal gastric cancer in our center.However,in this case,cardia lesion here was defined early stage tumor,thereby laparoscopic total gastrectomy was performed with D2-No.10 lymphadectomy.