腹腔镜根治性全胃切除重建术

Laparoscopic radical total gastrectomy and reconstruction

患者,59岁男性,术前诊断:胃体腺癌(c T3N1+M0)。拟行腹腔镜根治性全胃切除术。手术思路:1.打开胃结肠韧带,游离横结肠系膜前叶2.显露并离断胃网膜右静脉根部,清扫14V组淋巴结,显露胃十二指肠动脉,于根部离断胃网膜右动脉,清扫6组淋巴结。3.游离胰腺被膜,清扫7、8、9组淋巴结。沿肝总动脉后方显露门静脉,清扫12a组淋巴结。显露胃十二指肠动脉、肝固有动脉,离断胃右动脉,清扫5组淋巴结。游离肝胃韧带至贲门右侧,清扫1组淋巴结。4.沿脾动脉游离,显露脾门血管,清扫10、11组淋巴结。游离贲门左侧,清扫2组淋巴结。5.采取腹部辅助小切口完成胃肠Roux-en-Y重建。

A 59 year old male patent with cT3N1 ＋ M0 gastric cancer underwent laparoseopic radical total gastrectomy. Operative procedures： Firstly, to dissect the gastroeolie ligament, and to dissect anterior lobe of transverse mesocolon. Second, to expose and cut the right vein of the gastric omentnm at the root, with clearance of NO. 14v lymph nodes, and to expose the gastroduodenal artery., and to cut the right artery of the gastric omentmn at the root, with clearance of NO. 6 lymph nodes. Third, to dissect capsule of pancreas, with clearance of NO. 7, 8 and 9 lymph nodes, to expose the portal vein under the common hepatic artery with clearance of NO. 12a lymph nodes. Then to expose the gastroduodenal artery, proper hepatic artery and to cut the right gastric artery with clearance of NO. 5 lymph nodes. To clear NO1 . lymph nodes after release liver and gastric ligaments to the right side of the cardia. Fourth, to explore along the splenic artery, expose the blood vessels of the splenic portal area, with clearance of NO. 10,11 lymph nodes. and to dissect the left side of the eardia, with clearance of NO. 2 lymph nodes. At last, reconstruct the digestive tract was achieved by using Roux-en-Y anastomosis through small abdominal incision.