全腹腔镜下远端胃癌根治术三角吻合术

Delta-shaped anastomosis technique in total laparoscopic distal gastrectomy

先确定肿瘤位置,沿横结肠边缘超声刀游离横结肠系膜前叶,向右游离至结肠肝曲,左至脾曲,离断网膜左血管,清扫4sb,4d淋巴结;沿结肠中动脉及其分支分离,向上暴露肠系膜上静脉、右结肠静脉、胃网膜右静脉,骨骼化胃网膜右动脉于根部切断;裸化十二指肠下缘,暴露胃十二指肠动脉,肝总动脉胃左脾动脉和腹腔干,切断胃左动脉清扫第7.8.9.11p组淋巴结;向下剥离裸化肝十二指肠韧带,清扫第12a组淋巴结,并向上彻底清扫第1,3,5组淋巴结,使用内镜下直线切割吻合器离断十二指肠球部,胃体。扩大脐部穿刺孔至取出标本,缝合切口。重建气腹,行胃大弯和十二指肠后壁三角吻合。

Firstly to determine the location of tumor, along the edge of the tranverse colon, the anterior lobe of the mesocolon was dissected by using an ultrasonic scalpel, then mobiling right-towards to the hepatic flexure and left-towards to the splenic flexure. Secondly to dissect the left gastroepiploic vessel,the 4sb, 4d group lymph nodes were scavenged along the median colon arteries upwards to explore the superior mesenteric vein, right the colonic vein and right gastroepiploic vein. Right gatsroepiploic vein was skeletonized and cutted from the root and lower margin of the duodenum was exposed. Then to expose the gastroduodenal artery, common hepatic artery, left gastric artery, splenic artery and celiac trunk, finally the left gastric artery was sleketonized and 7,8,9 and lip groups of lymph nodes were scavenged. After stripping down-towards the hepatoduodenal ligament, 12a group of lymph nodes was resected. Up-towards, 1,3,5 groups of lymph nodes were removed. An endoscopic linear cutting anastomat was used to divide duodenal bulb and gastric body. A 3cm incision was made for the removal of specimen. Then incision was closed, and pneumoperitoneum was made for the delta-shaped anastomosis of the gastric greater curvature and duodenum.