腹腔镜胃癌根治术

Laparoscopic radical gastrectomy for gastric cancer

应用电钩沿横结肠与大网膜附着处分离大网膜分别至结肠脾曲及结肠肝区。用超声刀沿胰腺被膜分离,至胰腺上缘显露近脾门处的脾动静脉主干向脾门解剖,清扫第10、11组淋巴结;显露胃网膜左血管根部并离断,向上离断部分胃短血管后,裸化胃大弯,清扫第4组淋巴结。沿胰腺下缘胰后间隙解剖,显露肠系膜上静脉,清扫14v组淋巴结,于胃网膜右静脉汇入胃结肠静脉干处夹闭,显露胃网膜右动脉根部并夹闭,清扫第6组淋巴结。沿胰腺上缘打开胃胰皱襞进入胰后间隙解剖肝总动脉及腹腔动脉干,游离并显露胃左动、静脉,脾动脉及部分肝总动脉,根部切断胃左动、静脉,清扫7、8、9组淋巴结。显露肝总动脉,清扫第8a组淋巴结,显露肝固有动脉,显露胃右动脉根部,夹闭切断胃右动脉,清扫第5、12组淋巴结。沿小网膜与胃小弯前壁附着处切除小网膜,裸化胃壁,清扫第3、5组淋巴结。

By using electric hook, omentum majus was separated from the attachment sites of colon transversum. The left and right boundaries of this process were the splenic and hepatic flexure of the colon, respectively. By using ultrasonic scalpel, superior border of the pancreas was dissected to expose the trunk of the splenic artery and vein which were near to the hilus lienis. Dissection of group 10 and 11 lymph nodes were performed. The root of the left gastroepiploic artery was exposed and was clipped, then separated tissue upwards to clip the partial short gastric artery, along the greater curvature of the stomach to reseet the omentum majus and to clean the group 4 lymph nodes. Dissection was then performed along the posterior gap of the pancreas in which the lower margin of the pancreatic neck was located and the superior mesenteric vein was exposed and group 14 lymph nodes were cleaned. The position where the right gastro-omental vein affluxed into the gastrocolic trunk was clipped and then the right gastro-omental vein was cutted off, group 6 lymph nodes were then cleaned, nd group 8a lymph nodes was cleaned. The root of right gastric artery was exposed and cutted off, while group 12 and 5 lymph nodes were cleaned. Gastric wall was naked And groups 3 and 5 lymph nodes were cleaned at last.